Basic Information
| Provider Information | |||||||||
| NPI: | 1386664308 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRABOWSKI | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2290 | ||||||||
| Address2: | |||||||||
| City: | MANITOWOC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 542212290 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203208600 | ||||||||
| FaxNumber: | 9203208662 | ||||||||
| Practice Location | |||||||||
| Address1: | 339 REED AVE | ||||||||
| Address2: | |||||||||
| City: | MANITOWOC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 542202020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9203208600 | ||||||||
| FaxNumber: | 9203208662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 06/03/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 27212-020 | WI | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 390806395 | 01 | CIGNA | OTHER | 31444900 | 05 | WI | MEDICAID | P00074991 | 01 | RAILROAD MEDICARE | OTHER | 36125 | 01 | NETWORK HEALTH PLAN | OTHER |