| Organization Name: | QUAD MED LLC |
| NPI Number: | 1053719377 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LINDSAY BONAVENTURA (NURSE PRACTITIONER) |
| Mailing Address: | 201 Ferguson Rd Michigan City |
| State: | IN US |
| Postal Code: | 463602407 |
| Phone Number: | 3177916691 |
| Fax Number: | 3177916680 |
| NPI Enumeration Date: | 12/18/2014 |
| NPI Last Update Date: | 12/18/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 71004237A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |