Healthcare Provider Details

I. General information

NPI: 1467480681
Provider Name (Legal Business Name): JOHN T. GRANDONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 THEDA CLARK MEDICAL PLZ STE 240
NEENAH WI
54956-2790
US

IV. Provider business mailing address

3 NEENAH CTR
NEENAH WI
54956-3070
US

V. Phone/Fax

Practice location:
  • Phone: 920-729-2710
  • Fax: 920-727-4511
Mailing address:
  • Phone: 920-830-5900
  • Fax: 920-830-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number21696
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number21696
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: