Provider Demographics
NPI:1699595272
Name:QUIGLEY, BENJAMEN
Entity type:Individual
Prefix:
First Name:BENJAMEN
Middle Name:
Last Name:QUIGLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17252 ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48350-1194
Mailing Address - Country:US
Mailing Address - Phone:248-825-2045
Mailing Address - Fax:
Practice Address - Street 1:6770 DIXIE HWY STE 200
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-5113
Practice Address - Country:US
Practice Address - Phone:248-276-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator