Provider Demographics
NPI:1316990161
Name:GRONSKI, DAVID J (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:GRONSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2501 W BELTLINE HWY
Mailing Address - Street 2:SUITE 601
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2318
Mailing Address - Country:US
Mailing Address - Phone:608-294-6464
Mailing Address - Fax:608-288-6495
Practice Address - Street 1:2501 W BELTLINE HWY
Practice Address - Street 2:SUITE 601
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2318
Practice Address - Country:US
Practice Address - Phone:608-294-6464
Practice Address - Fax:608-288-6495
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI33507-020207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1316990161Medicaid
WI080090662Medicare PIN