Individual
GRANT ALEXANDER KARLSSON ELLIFSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1801 W WISCONSIN AVE, MILWAUKEE, WI 53233-2186
(608) 422-0516
Mailing address
2261 N 61ST ST, MILWAUKEE, WI 53213-1501
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
6001202
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/30/2023
Last updated
06/21/2024
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