Individual
ROBERT J GRASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8615
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
(920) 926-8370
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
43234
WI
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
43234
WI
208000000X
Pediatrics Physician
43234
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110221540
RAILROAD MEDICARE
WI
05
—
34090300
—
WI
Enumeration date
11/03/2005
Last updated
10/18/2024
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