Healthcare Provider Details

I. General information

NPI: 1689783722
Provider Name (Legal Business Name): MICHAEL PATRICK QUIRK PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18404 N TATUM BLVD SUITE 202
PHOENIX AZ
85032-1510
US

IV. Provider business mailing address

PO BOX 29870
PHOENIX AZ
85038-9870
US

V. Phone/Fax

Practice location:
  • Phone: 480-473-3668
  • Fax: 480-473-3668
Mailing address:
  • Phone: 602-385-2115
  • Fax: 480-422-6551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2272
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2136
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: