Provider Demographics
NPI:1326227323
Name:GRONAU, RACHEL TARA JOY (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:TARA JOY
Last Name:GRONAU
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 1:1038 E GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-1921
Mailing Address - Country:US
Mailing Address - Phone:262-740-0681
Mailing Address - Fax:262-740-0776
Practice Address - Street 1:1038 E GENEVA ST
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-1921
Practice Address - Country:US
Practice Address - Phone:262-740-0681
Practice Address - Fax:262-740-0776
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine