Healthcare Provider Details

I. General information

NPI: 1871561936
Provider Name (Legal Business Name): AMY R GRELLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 BREWERY RD
CROSS PLAINS WI
53528
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-798-3344
  • Fax: 608-798-1369
Mailing address:
  • Phone: 608-829-5485
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40511
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: