Healthcare Provider Details

I. General information

NPI: 1437116357
Provider Name (Legal Business Name): LEE M GRUENWALD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 COUNTY ROAD K
FOND DU LAC WI
54937-6007
US

IV. Provider business mailing address

751 COUNTY ROAD K
FOND DU LAC WI
54937-6007
US

V. Phone/Fax

Practice location:
  • Phone: 920-929-3800
  • Fax:
Mailing address:
  • Phone: 920-929-3800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number44431
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: