Healthcare Provider Details

I. General information

NPI: 1891788360
Provider Name (Legal Business Name): LAURIE GRUNSKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20611 WATERTOWN RD STE D&E
WAUKESHA WI
53186-1871
US

IV. Provider business mailing address

20611 WATERTOWN RD STE D&E
WAUKESHA WI
53186-1871
US

V. Phone/Fax

Practice location:
  • Phone: 262-256-0676
  • Fax: 262-205-4210
Mailing address:
  • Phone: 262-256-0676
  • Fax: 262-205-4210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number31318-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: