MEDICARE: Q R & R LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	AB053422	MI

General Provider Information

NPI Number	:	1821256702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	Q R & R LLC

Provider Business Mailing Address
First Line	:	2329 W GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48208-1205
Country	:	US
Telephone Number	:	313-874-3129
Fax Number	:	313-875-5442

Provider Business Practice Location Address
First Line	:	2329 W GRAND BLVD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48208-1205
Country	:	US
Telephone Number	:	313-874-3129
Fax Number	:	313-875-5442

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MRS. BETH JENKINS
Credential	:
Telephone Number	:	313-874-3129

Provider Enumeration Date	:	05/28/2008
Last Update Date	:	10/09/2008

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Directions to “Q R & R LLC ” Practice Location

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