Individual
ADAM C GRIMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
N15W28300 GOLF RD, PEWAUKEE, WI 53072-4800
(262) 303-5055
(262) 303-5057
Mailing address
N15W28300 GOLF RD, PEWAUKEE, WI 53072-4800
(262) 303-5055
(262) 303-5057
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
100887-875
WI
363A00000X
Physician Assistant
Primary
7534
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100046348
—
WI
Enumeration date
07/02/2012
Last updated
08/28/2023
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