Provider Demographics
NPI:1821040528
Name:QUINN, THERESA M (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:M
Last Name:QUINN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N79W14684 APPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-4308
Mailing Address - Country:US
Mailing Address - Phone:262-229-4060
Mailing Address - Fax:262-229-4062
Practice Address - Street 1:N79W14684 APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-4308
Practice Address - Country:US
Practice Address - Phone:262-229-4060
Practice Address - Fax:262-229-4062
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45074208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
001856578ZOtherHUMANA
WI34355300Medicaid
WI1821040528Medicaid
WI1821040528Medicaid
G65592Medicare UPIN