Mark Quenneville, CO, CPED

Primary specialty

OrthotistTaxonomy code 222Z00000X

Practice address

4424 S Pennsylvania Ave
Lansing, MI 48910-7625

Phone

(517) 394-5850

NPI assigned

Mar 12, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363046400000",
    "number": "1609117878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4424 S PENNSYLVANIA AVE",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489107625",
            "telephone_number": "517-394-5850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4424 S PENNSYLVANIA AVE",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489107625",
            "telephone_number": "517-394-5850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUENNEVILLE",
        "first_name": "MARK",
        "credential": "CO, CPED",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-12",
        "last_updated": "2013-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "224L00000X",
            "taxonomy_group": "",
            "desc": "Pedorthist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthotist in Lansing, MI
• Providers in Lansing, MI by specialty
• Orthotist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.