Individual
DAVID L GROTELUSCHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1726 SHAWANO AVE, GREEN BAY, WI 54303-3216
(920) 884-3135
(920) 884-3144
Mailing address
1726 SHAWANO AVE, GREEN BAY, WI 54303-3216
(920) 884-3135
(920) 884-3144
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
44953
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104894036
—
MI
05
—
34871500
—
WI
01
—
DG088696
MICHIGAN BCBS
MI
Enumeration date
04/19/2006
Last updated
12/20/2021
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