Individual
DR. DAVID W GRAMBOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2350 N LAKE DR, SUITE 400, MILWAUKEE, WI 53211-4528
(414) 271-1633
(414) 271-5071
Mailing address
4425 N PORT WASHINGTON RD, ATTN: CSMCP CLINIC CREDENTIALING, GLENDALE, WI 53212-1082
(414) 271-1633
(414) 271-5071
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
28836
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31921000
—
WI
Enumeration date
06/04/2006
Last updated
06/12/2012
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