Individual
GRANT KLOTZBUECHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2065 HALF DAY RD, DEERFIELD, IL 60015-1241
(920) 980-4537
Mailing address
4834 STONEFIELD RD, SHEBOYGAN, WI 53083-5616
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/24/2016
Last updated
08/24/2016
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