Individual
ROY GRANT IBRADO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3124 S TAYLOR AVE, MILWAUKEE, WI 53207-2724
(414) 617-7053
Mailing address
3925 S 1ST ST, MILWAUKEE, WI 53207-4301
(414) 617-7053
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
195948-30
WI
Other
Enumeration date
04/19/2014
Last updated
07/31/2019
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