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General NPI Number Information
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NPI Number | 1225150709
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 345 EXECUTIVE PKWY SUITE M4
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City | ROCKFORD
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State | IL
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Zip | 61107-5340
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Country | US
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Telephone | 815-399-1141
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Fax | 815-397-7816
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Provider Business Mailing Address
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Address Line | 345 EXECUTIVE PKWY SUITE M4
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City | ROCKFORD
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State | IL
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Zip | 61107-5340
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Country | US
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Telephone | 815-399-1141
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Fax | 815-397-7816
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. JEFFREY GROSSMAN
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Credential | MD
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Telephone | 815-399-1141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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