MEDICARE: DR. KURT WALTER GRELCK D.O.

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
1	207R00000X	Internal Medicine Physician	OS10384	FL
2	207N00000X	Dermatology Physician	56822-021	WI

General Provider Information

NPI Number	:	1619203858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KURT WALTER GRELCK D.O.

Provider Business Mailing Address
First Line	:	801 YORK ST
Second Line	:
City	:	MANITOWOC
State	:	WI
Zip	:	54220-4630
Country	:	US
Telephone Number	:	920-663-9008
Fax Number	:	920-663-9009

Provider Business Practice Location Address
First Line	:	5501A VERN HOLMES DR
Second Line	:
City	:	STEVENS POINT
State	:	WI
Zip	:	54482-9791
Country	:	US
Telephone Number	:	715-849-5333
Fax Number	:	715-849-4083

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2009
Last Update Date	:	07/27/2023

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