Healthcare Provider Details

I. General information

NPI: 1174089130
Provider Name (Legal Business Name): QUAD/MED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2019
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S 108TH ST
WEST ALLIS WI
53214-1145
US

IV. Provider business mailing address

W227N6103 SUSSEX RD
SUSSEX WI
53089-3969
US

V. Phone/Fax

Practice location:
  • Phone: 414-566-3725
  • Fax: 414-566-3900
Mailing address:
  • Phone: 414-566-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

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