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General NPI Number Information
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NPI Number | 1306871769
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Entity Type | Individual
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Provider Name | GREGORY M GREWE MD
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Gender | Male
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 12/05/2017
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Provider Practice Location Address
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Address Line | 1789 SHAWANO AVE
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City | GREEN BAY
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State | WI
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Zip | 54303
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Country | US
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Telephone | 920-499-1428
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Fax | 920-499-5808
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Provider Business Mailing Address
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Address Line | 1789 SHAWANO AVE
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City | GREEN BAY
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State | WI
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Zip | 54303-3243
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Country | US
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Telephone | 920-499-1428
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Fax | 920-499-5808
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 30051-020
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License Number State | WI
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