Basic Information
| Provider Information | |||||||||
| NPI: | 1477118958 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUADE | ||||||||
| FirstName: | LESHEA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 707 E MILBANK AVE | ||||||||
| Address2: | |||||||||
| City: | MILBANK | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572521319 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7635678246 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1115 E 20TH ST | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6055751644 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2019 | ||||||||
| LastUpdateDate: | 08/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 13584 | SD | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.