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Individual

DR. NIKOLO C QUINONES

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1300 SOUTH DRIVE, WINNEBAGO, WI 54985-0009
(920) 235-4910
(920) 237-2043
Mailing address
PO BOX 9, WINNEBAGO, WI 54985-0009
(920) 235-4910
(920) 237-2043

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
39923
WI
283Q00000X
Psychiatric Hospital
39923
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
32449800
WI
01
450030793
MEDICARE PTAN
WI
01
711290189
MEDICARE PTAN
WI
Enumeration date
08/23/2006
Last updated
03/07/2023
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