MEDICARE: QUAD/MED, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1134509599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUAD/MED, LLC

Provider Business Mailing Address
First Line	:	W227N6103 SUSSEX RD
Second Line	:
City	:	SUSSEX
State	:	WI
Zip	:	53089-3969
Country	:	US
Telephone Number	:	414-566-8400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 S 18TH AVE
Second Line	:
City	:	WEST BEND
State	:	WI
Zip	:	53095-8796
Country	:	US
Telephone Number	:	262-338-1427
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	ROBERT L POULSEN
Credential	:
Telephone Number	:	414-566-8400

Provider Enumeration Date	:	06/01/2015
Last Update Date	:	07/14/2025

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Directions to “QUAD/MED, LLC ” Practice Location

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