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NPI Code Detail

MEDICARE: SANDRA GROENEWOLD MD

MEDICARE: SANDRA GROENEWOLD 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
1207Q00000XFamily Medicine Physician36918WI
22084P0800XPsychiatry Physician36918WI

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 : 1881620722
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA GROENEWOLD MD
Provider Business Mailing Address
First Line : 3 NEENAH CTR
Second Line :
City : NEENAH
State : WI
Zip : 54956-3070
Country : US
Telephone Number : 920-720-2300
Fax Number :
Provider Business Practice Location Address
First Line : 1095 MIDWAY RD
Second Line :
City : MENASHA
State : WI
Zip : 54952-1115
Country : US
Telephone Number : 920-720-2300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2006
Last Update Date : 08/04/2023

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Directions to “ SANDRA GROENEWOLD MD” Practice Location

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