1033249255 NPI number — DR. BARIKA MARISE BUTLER-QUARLES MD

Table of content: DR. BARIKA MARISE BUTLER-QUARLES MD (NPI 1033249255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033249255 NPI number — DR. BARIKA MARISE BUTLER-QUARLES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTLER-QUARLES
Provider First Name:
BARIKA
Provider Middle Name:
MARISE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033249255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18530 MACK AVE # 163
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GROSSE POINTE FARMS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48236-3254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-855-5745
Provider Business Mailing Address Fax Number:
313-355-1567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18530 MACK AVE
Provider Second Line Business Practice Location Address:
116
Provider Business Practice Location Address City Name:
GROSSE POINTE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48236-3254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-855-5745
Provider Business Practice Location Address Fax Number:
313-355-1567
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  4301088119 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X , with the licence number: 4301088119 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0930480 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1250684 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 600704916 . This is a "MAGELLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 9080659 . This is a "AETNA/COFINITY" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 683816 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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