Individual
KONRAD WALDEMAR DE GRANDVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2900 W OKLAHOMA AVE, MILWAUKEE, WI 53215
(414) 649-6732
Mailing address
2900 W OKLAHOMA AVE, AURORA ST LUKES FAMILY MEDICINE RESIDENCY, MILWAUKEE, WI 53215
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
313994
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100011098
—
WI
Enumeration date
02/15/2008
Last updated
02/02/2023
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