Basic Information
| Provider Information | |||||||||
| NPI: | 1316990161 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRONSKI | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 W BELTLINE HWY | ||||||||
| Address2: | SUITE 601 | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537132318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082946464 | ||||||||
| FaxNumber: | 6082886495 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 W BELTLINE HWY | ||||||||
| Address2: | SUITE 601 | ||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537132318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082946464 | ||||||||
| FaxNumber: | 6082886495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 11/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 33507-020 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1316990161 | 05 | WI | MEDICAID |