Healthcare Provider Details

I. General information

NPI: 1386165918
Provider Name (Legal Business Name): QUAD/MED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 E. WASHINGTON ST. #1115
WEST BEND WI
53095
US

IV. Provider business mailing address

N64W23110 MAIN STREET
SUSSEX WI
53089
US

V. Phone/Fax

Practice location:
  • Phone: 844-827-1814
  • 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