Basic Information
| Provider Information | |||||||||
| NPI: | 1427027077 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MICHAEL B MACQUARRIE MD INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | NORTH TAHOE EMERGENCY PHYSICIANS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 CUMMINS DR STE D | ||||||||
| Address2: | |||||||||
| City: | MODESTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953586411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103502666 | ||||||||
| FaxNumber: | 5108799061 | ||||||||
| Practice Location | |||||||||
| Address1: | 880 ALDER AVE | ||||||||
| Address2: | |||||||||
| City: | INCLINE VILLAGE | ||||||||
| State: | NV | ||||||||
| PostalCode: | 894518335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305823220 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 03/19/2014 | ||||||||
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| AuthorizedOfficialLastName: | MACQUARRIE | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | M.D./OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5305823140 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | G23578 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services |
ID Information
| ID | Type | State | Issuer | Description | GR0090630 | 05 | CA | MEDICAID |