Healthcare Provider Details

I. General information

NPI: 1013921303
Provider Name (Legal Business Name): MIQUIABAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 07/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S SHOOP AVE
WAUSEON OH
43567-1702
US

IV. Provider business mailing address

5620 SOUTHWYCK BLVD
TOLEDO OH
43614-1501
US

V. Phone/Fax

Practice location:
  • Phone: 419-335-2015
  • Fax:
Mailing address:
  • Phone: 419-335-2015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ESTELA MIQUIABAS
Title or Position: PRESIDENT
Credential: MD
Phone: 419-335-3038