Healthcare Provider Details

I. General information

NPI: 1871438952
Provider Name (Legal Business Name): CONNOR QUILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12800 N LAKE SHORE DR
MEQUON WI
53097-2418
US

IV. Provider business mailing address

127 WILLIAMS DR
SCHAUMBURG IL
60193-1361
US

V. Phone/Fax

Practice location:
  • Phone: 262-243-5700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: