Individual
THOMAS W GROSSMAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
608 W BROWN ST, WAUPUN, WI 53963-1702
(920) 324-6802
Mailing address
420 E DIVISION ST, FOND DU LAC, WI 54935-4560
(920) 926-8340
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
36420
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32523000
—
WI
Enumeration date
02/15/2006
Last updated
02/17/2016
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