Healthcare Provider Details

I. General information

NPI: 1679063408
Provider Name (Legal Business Name): GRACE KATHLEEN DEHOFF DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 10/06/2023
Certification Date: 10/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

2900 W OKLAHOMA AVE
MILWAUKEE WI
53215-4330
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-6000
  • Fax:
Mailing address:
  • Phone: 414-649-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number81196
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: