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NPI Code Detail

MEDICARE: DR. GRACE ELLEN FLOOD M.D.

MEDICARE: DR. GRACE ELLEN FLOOD M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician42538WI

General Provider Information

NPI Number : 1407398688
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GRACE ELLEN FLOOD M.D.
Provider Business Mailing Address
First Line : 3245 HARMONY ST
Second Line :
City : SUN PRAIRIE
State : WI
Zip : 53590-7035
Country : US
Telephone Number : 608-318-0594
Fax Number :
Provider Business Practice Location Address
First Line : 749 UNIVERSITY ROW
Second Line : MC: 9925
City : MADISON
State : WI
Zip : 53705-1465
Country : US
Telephone Number : 608-209-7832
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2016
Last Update Date : 11/05/2016

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