Healthcare Provider Details

I. General information

NPI: 1376527721
Provider Name (Legal Business Name): PAUL EDWARD QUINLAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 WEST CIRCLE DRIVE
EAST LANSING MI
48824-1037
US

IV. Provider business mailing address

804 SERVICE RD # A201
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-884-6546
  • Fax: 517-432-9460
Mailing address:
  • Phone: 517-884-2976
  • Fax: 517-432-3928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101011011
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number5101011011
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: