Healthcare Provider Details

I. General information

NPI: 1134235088
Provider Name (Legal Business Name): FERNANDO LUIS QUIRINDONGO-SOLANO DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 MEETING ST
WEST COLUMBIA SC
29169-7535
US

IV. Provider business mailing address

7243 CHASE RD
DEARBORN MI
48126-1301
US

V. Phone/Fax

Practice location:
  • Phone: 727-796-6900
  • Fax:
Mailing address:
  • Phone: 313-582-6222
  • Fax: 313-582-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002226
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: