Individual
SUSAN MITHOFF QUADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
2299 WEST RD, TRENTON, MI 48183-3615
(734) 676-4500
(734) 676-1587
Mailing address
2299 WEST RD, TRENTON, MI 48183-3615
(734) 676-4500
(734) 676-1587
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003686
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900130980
TAX ID
MI
01
—
900H22910
BLUE CROSS BLUE SHIELD OF MICHIGAN
MI
Enumeration date
04/06/2006
Last updated
06/15/2015
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