Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 6801082748 | MI |
NPI | 1386108793 |
---|---|
Provider Name | Dave Quilliam |
First Address | Grayling, MI 49738-2015 |
Second Address | Grayling, MI 49738-2015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2019 |
Last Update Date | 30/01/2019 |