Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301104418 | MI |
N | 111NI0900X | Internist | 4301104418 | MI |
Y | 207RH0000X | Hematologist | 4301104418 | MI |
N | 207RH0000X | Hematologist | MD046022L | PA |
NPI | 1164487120 |
---|---|
Provider Name | Albert Thomas Quiery JR. |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48109-5000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 16/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0012853620001 | (05) | PA |
E12407 | (02) |