Healthcare Provider Details

I. General information

NPI: 1336344928
Provider Name (Legal Business Name): DAVID S GRENDA MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 BELLINGER STREET
EAU CLAIRE WI
54703-5222
US

IV. Provider business mailing address

PO BOX 860912 PROVIDER ENROLLMENT
MINNEAPOLIS MN
55486-0912
US

V. Phone/Fax

Practice location:
  • Phone: 715-833-5222
  • Fax:
Mailing address:
  • Phone: 507-284-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number69909
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number86153-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number69909
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: