Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301108218 | MI |
NPI | 1003203647 |
---|---|
Provider Name | Quinn Wicks |
First Address | Richmond, VA 23220-2047 |
Second Address | Detroit, MI 48235 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2015 |
Last Update Date | 09/07/2018 |