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General NPI Number Information
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NPI Number | 1467480681
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Entity Type | Individual
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Provider Name | JOHN T. GRANDONE M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 09/09/2024
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Provider Practice Location Address
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Address Line | 200 THEDA CLARK MEDICAL PLZ STE 240
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City | NEENAH
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State | WI
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Zip | 54956-2790
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Country | US
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Telephone | 920-729-2710
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Fax | 920-727-4511
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Provider Business Mailing Address
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Address Line | 3 NEENAH CTR
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City | NEENAH
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State | WI
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Zip | 54956-3070
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Country | US
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Telephone | 920-830-5900
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Fax | 920-830-5910
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 21696
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 21696
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License Number State | WI
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