Individual
TAMARA GRISSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1284 N SUMMIT AVE, OCONOMOWOC, WI 53066-4459
(262) 560-3700
(262) 560-3759
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2652-023
WI
363AS0400X
Surgical Physician Assistant
2652-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100011873
—
WI
Enumeration date
09/03/2010
Last updated
10/13/2025
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