Individual
BRENDA J GRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8615
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
(920) 926-8370
Taxonomy
Speciality
Code
Description
License number
State
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
Primary
43233
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110221539
RAILROAD MEDICARE
WI
05
—
34090400
—
WI
Enumeration date
11/03/2005
Last updated
12/10/2020
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