Individual
DR. FREDERICK LANE GROUTAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
130 2ND ST, NEENAH, WI 54956-2883
(920) 720-7398
Mailing address
511 BROAD ST, 104, MENASHA, WI 54952-3270
(262) 389-0236
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
52651-20
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/08/2008
Last updated
09/06/2012
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