Healthcare Provider Details

I. General information

NPI: 1679979041
Provider Name (Legal Business Name): QUAD/MED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 S TIGER DR
YORKTOWN IN
47396
US

IV. Provider business mailing address

W227N6103 SUSSEX RD
SUSSEX WI
53089-3969
US

V. Phone/Fax

Practice location:
  • Phone: 888-417-1001
  • Fax:
Mailing address:
  • Phone: 414-566-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT L POULSEN
Title or Position: CFO
Credential:
Phone: 414-566-8400