Provider Demographics
NPI:1578511085
Name:QUADRACCI, LEONARD JON (MD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:JON
Last Name:QUADRACCI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:555 S 108TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-1100
Mailing Address - Country:US
Mailing Address - Phone:414-566-3803
Mailing Address - Fax:414-566-3866
Practice Address - Street 1:555 S 108TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-1100
Practice Address - Country:US
Practice Address - Phone:414-566-3803
Practice Address - Fax:414-566-3866
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI37230-020207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIA05409Medicare UPIN