Individual
GRANT MICHAEL ROETHEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1414 N TAYLOR DR, SHEBOYGAN, WI 53081-1988
(920) 476-6300
Mailing address
1414 N TAYLOR DR, SHEBOYGAN, WI 53081-1988
(920) 946-1743
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
17248-33
WI
Other
Enumeration date
08/07/2025
Last updated
09/19/2025
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