Provider Demographics
NPI:1144498239
Name:GRIEVE, BONNIE-JO MCLEAN (MD)
Entity type:Individual
Prefix:DR
First Name:BONNIE-JO
Middle Name:MCLEAN
Last Name:GRIEVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W262N2442 DEER HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-4572
Mailing Address - Country:US
Mailing Address - Phone:414-510-0603
Mailing Address - Fax:414-691-1911
Practice Address - Street 1:W262N2442 DEER HAVEN DR
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-4572
Practice Address - Country:US
Practice Address - Phone:414-510-0603
Practice Address - Fax:414-691-1911
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18939-020208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30374000Medicaid
WIB51409Medicare UPIN