Provider Demographics
NPI:1467480681
Name:GRANDONE, JOHN T (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:GRANDONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3 NEENAH CTR
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-3070
Mailing Address - Country:US
Mailing Address - Phone:920-830-5900
Mailing Address - Fax:920-830-5910
Practice Address - Street 1:200 THEDA CLARK MEDICAL PLZ STE 240
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2790
Practice Address - Country:US
Practice Address - Phone:920-729-2710
Practice Address - Fax:920-727-4511
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI21696174400000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI450030783OtherMEDICARE
WI30246700Medicaid
WI711290180OtherMEDICARE PTAN
WI30246700Medicaid
WI450030783OtherMEDICARE