Healthcare Provider Details

I. General information

NPI: 1114974581
Provider Name (Legal Business Name): QUAD CITY RHEUMATOLOGY SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 18TH AVE
ROCK ISLAND IL
61201-3614
US

IV. Provider business mailing address

2202 18TH AVE
ROCK ISLAND IL
61201-3614
US

V. Phone/Fax

Practice location:
  • Phone: 309-762-3400
  • Fax: 309-764-3878
Mailing address:
  • Phone: 309-793-3400
  • Fax: 309-793-7323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL F MINITER
Title or Position: MD
Credential: MD
Phone: 309-793-3400