Basic Information
| Provider Information | |||||||||
| NPI: | 1669459871 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | QUIREY | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14275 MIDWAY RD | ||||||||
| Address2: | SUTIE 400 | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750013614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2149328029 | ||||||||
| FaxNumber: | 6102714245 | ||||||||
| Practice Location | |||||||||
| Address1: | 2560 N. SHADELAND AVE. | ||||||||
| Address2: | SUITE A | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462191706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172758072 | ||||||||
| FaxNumber: | 3172758124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 05/01/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZD0900X | 01042715A | IN | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZP0102X | 01042715A | IN | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 200160680A | 05 | IN | MEDICAID | 220024759 | 01 | IN | RAILROAD MEDICARE | OTHER | 000000092721 | 01 | IN | ANTHEM | OTHER | 000000006032 | 01 | IN | MPLAN | OTHER | 603792 | 01 | KY | WELLCARE | OTHER | 7100076770 | 05 | KY | MEDICAID |