Provider Demographics
NPI:1588766539
Name:QUIRK, MICHAEL GEORGE (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:QUIRK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22872 JOHN SILVER LN
Mailing Address - Street 2:
Mailing Address - City:CUDJOE KEY
Mailing Address - State:FL
Mailing Address - Zip Code:33042-4244
Mailing Address - Country:US
Mailing Address - Phone:305-744-0139
Mailing Address - Fax:
Practice Address - Street 1:1511 TRUMAN AVE
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-7252
Practice Address - Country:US
Practice Address - Phone:305-294-4004
Practice Address - Fax:305-254-6043
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 3349363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA3349OtherSTATE LICENSE
FLE0696Medicare ID - Type UnspecifiedPROVIDER #