Provider Demographics
NPI:1063197887
Name:WIEGEL, QUADE R
Entity type:Individual
Prefix:
First Name:QUADE
Middle Name:R
Last Name:WIEGEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12634 TAMA RUN RD
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530-9613
Mailing Address - Country:US
Mailing Address - Phone:608-482-1040
Mailing Address - Fax:
Practice Address - Street 1:12634 TAMA RUN RD
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:WI
Practice Address - Zip Code:53530-9613
Practice Address - Country:US
Practice Address - Phone:608-482-1040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program