Organization
UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
Active
Other names
Retina Consultants, UWMF
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY GROSSMAN MD (PRESIDENT AND CEO)
(815) 399-1141
Entity
Organization
Contact information
Practice address
345 EXECUTIVE PKWY, SUITE M4, ROCKFORD, IL 61107-5340
(815) 399-1141
(815) 397-7816
Mailing address
345 EXECUTIVE PKWY, SUITE M4, ROCKFORD, IL 61107-5340
(815) 399-1141
(815) 397-7816
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10121807
BCBS OF IL GROUP NUMBER
IL
Enumeration date
04/04/2007
Last updated
08/22/2020
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