Individual
DR. JAIME QUEZADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
350 PELLER RD, LAKE GENEVA, WI 53147-4543
(262) 249-0221
(262) 249-0633
Mailing address
350 PELLER RD, LAKE GENEVA, WI 53147-4543
(262) 249-0221
(262) 249-0633
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
36520
WI
207Q00000X
Family Medicine Physician
Primary
47086-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34581200
—
WI
Enumeration date
09/28/2006
Last updated
03/07/2023
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