Individual
CRAIG QUANDT-WALLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1818 N MEADE ST, APPLETON, WI 54911-3454
(800) 968-6866
Mailing address
PO BOX 88215, MILWAUKEE, WI 53288-0001
(800) 968-6866
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
1346023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41930500
—
WI
01
—
970028908
RAILROAD MEDICARE
WI
Enumeration date
07/26/2005
Last updated
08/01/2023
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