Healthcare Provider Details

I. General information

NPI: 1427027077
Provider Name (Legal Business Name): MICHAEL B MACQUARRIE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 ALDER AVE
INCLINE VILLAGE NV
89451-8335
US

IV. Provider business mailing address

1601 CUMMINS DR STE D
MODESTO CA
95358-6411
US

V. Phone/Fax

Practice location:
  • Phone: 530-582-3220
  • Fax:
Mailing address:
  • Phone: 510-350-2666
  • Fax: 510-879-9061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberG23578
License Number StateCA

VIII. Authorized Official

Name: MICHAEL B MACQUARRIE
Title or Position: M.D./OWNER
Credential: M.D.
Phone: 530-582-3140