Individual
BRUCE G GRISWOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1700 W PARADISE DR, WEST BEND, WI 53095-9795
(262) 334-3451
Mailing address
1700 W PARADISE DR, WEST BEND, WI 53095-9795
(262) 334-3451
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21352
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30290500
—
WI
Enumeration date
10/24/2006
Last updated
04/01/2013
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