Organization
CMH PRIMARY CARE CLINIC MOUTAIN-PHYSICIAN DISPENSARY
Active
Other names
CMH Primary Care Clinic-Mountain
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS C GREMBAN II M.D. (PHYSICIAN DISPENSARY)
(715) 276-1600
Entity
Organization
Contact information
Practice address
14353 HWY 32 & 64, MOUNTAIN, WI 54149
(715) 276-1600
(715) 276-1800
Mailing address
14353 HWY 32 & 64, MOUNTAIN, WI 54149
(715) 276-1600
(715) 276-1800
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23967-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31756500
—
WI
01
—
395585708005
GREMBAN BC
WI
01
—
5128904
NCPDP
WI
Enumeration date
03/08/2007
Last updated
12/23/2021
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