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NPI Code Detail

MEDICARE: LEE M GRUENWALD MD

MEDICARE: LEE M GRUENWALD MD
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
12084P0804XChild & Adolescent Psychiatry Physician44431WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437116357
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEE M GRUENWALD MD
Provider Business Mailing Address
First Line : 4065 N 35TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53216-1705
Country : US
Telephone Number : 414-445-9180
Fax Number : 414-445-5995
Provider Business Practice Location Address
First Line : 4065 N 35TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53216-1705
Country : US
Telephone Number : 414-445-9180
Fax Number : 414-445-5995
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2006
Last Update Date : 07/10/2014

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