Provider Demographics
NPI:1417765173
Name:QMJ MEDICAL CENTER PC
Entity type:Organization
Organization Name:QMJ MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PRITI
Authorized Official - Middle Name:PADAMANABHA
Authorized Official - Last Name:SHETTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-787-1137
Mailing Address - Street 1:49902 TAHOE WAY
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-4483
Mailing Address - Country:US
Mailing Address - Phone:248-787-1137
Mailing Address - Fax:248-962-3496
Practice Address - Street 1:26237 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LATHRUP VILLAGE
Practice Address - State:MI
Practice Address - Zip Code:48076-4546
Practice Address - Country:US
Practice Address - Phone:248-945-1962
Practice Address - Fax:248-945-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty