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General NPI Number Information
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NPI Number | 1114974581
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Entity Type | Organization
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Legal Business Name | QUAD CITY RHEUMATOLOGY SC
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 02/04/2009
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Provider Practice Location Address
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Address Line | 2202 18TH AVE
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City | ROCK ISLAND
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State | IL
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Zip | 61201-3614
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Country | US
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Telephone | 309-762-3400
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Fax | 309-764-3878
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Provider Business Mailing Address
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Address Line | 2202 18TH AVE
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City | ROCK ISLAND
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State | IL
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Zip | 61201-3614
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Country | US
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Telephone | 309-793-3400
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Fax | 309-793-7323
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Authorized Official
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Title or Position | MD
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Name | DR. MICHAEL F MINITER
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Credential | MD
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Telephone | 309-793-3400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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