Individual
DR. MELISSA M GRUBE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
12800 N PORT WASHINGTON RD, MEQUON, WI 53097-2415
(262) 243-9600
(262) 243-9661
Mailing address
12800 N PORT WASHINGTON RD, MEQUON, WI 53097-2415
(262) 243-9600
(262) 243-9661
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
70308
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2017
Last updated
11/02/2020
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