Individual
JOHN T. GRANDONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
200 THEDA CLARK MEDICAL PLZ STE 240, NEENAH, WI 54956-2790
(920) 729-2710
(920) 727-4511
Mailing address
3 NEENAH CTR, NEENAH, WI 54956-3070
(920) 830-5900
(920) 830-5910
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
21696
WI
207RR0500X
Rheumatology Physician
Primary
21696
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30246700
—
WI
01
—
450030783
MEDICARE
WI
01
—
711290180
MEDICARE PTAN
WI
Enumeration date
06/28/2006
Last updated
09/09/2024
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