Provider Demographics
NPI:1992977417
Name:MARK C. MCQUIGGAN, M.D., P.C.
Entity type:Organization
Organization Name:MARK C. MCQUIGGAN, M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCQUIGGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-203-8955
Mailing Address - Street 1:7 N MAIN ST
Mailing Address - Street 2:SUITE # 207
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-5644
Mailing Address - Country:US
Mailing Address - Phone:586-203-8955
Mailing Address - Fax:
Practice Address - Street 1:7 N MAIN ST
Practice Address - Street 2:SUITE # 207
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-5644
Practice Address - Country:US
Practice Address - Phone:586-203-8955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARK C. MCQUIGGAN, M.D., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301023279302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization