Healthcare Provider Details

I. General information

NPI: 1134033368
Provider Name (Legal Business Name): QUAD/MED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 THACKERAY TRL STE 103
OCONOMOWOC WI
53066-4342
US

IV. Provider business mailing address

W227N6103 SUSSEX RD
SUSSEX WI
53089-3969
US

V. Phone/Fax

Practice location:
  • Phone: 414-566-8100
  • Fax:
Mailing address:
  • Phone: 414-566-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROBERT L POULSEN JR.
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 414-566-8400