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NPI Code Detail

MEDICARE: DR. JAIME QUEZADA MD

MEDICARE: DR. JAIME QUEZADA MD
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
1207Q00000XFamily Medicine Physician36520WI
2207Q00000XFamily Medicine Physician47086-20WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356432660
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAIME QUEZADA MD
Provider Business Mailing Address
First Line : 350 PELLER RD
Second Line :
City : LAKE GENEVA
State : WI
Zip : 53147-4543
Country : US
Telephone Number : 262-249-0221
Fax Number : 262-249-0633
Provider Business Practice Location Address
First Line : 350 PELLER RD
Second Line :
City : LAKE GENEVA
State : WI
Zip : 53147-4543
Country : US
Telephone Number : 262-249-0221
Fax Number : 262-249-0633
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 03/07/2023

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