Healthcare Provider Details

I. General information

NPI: 1154858959
Provider Name (Legal Business Name): MICHAEL SENA QUIST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 ERWIN RD
DURHAM NC
27705-4699
US

IV. Provider business mailing address

2022 E 105TH ST
CLEVELAND OH
44106
US

V. Phone/Fax

Practice location:
  • Phone: 919-681-3937
  • Fax:
Mailing address:
  • Phone: 216-444-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.145658
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number2021-01011
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: