Provider Demographics
NPI:1407398688
Name:FLOOD, GRACE ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:ELLEN
Last Name:FLOOD
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 1:3245 HARMONY ST
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-7035
Mailing Address - Country:US
Mailing Address - Phone:608-318-0594
Mailing Address - Fax:
Practice Address - Street 1:749 UNIVERSITY ROW
Practice Address - Street 2:MC: 9925
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-1465
Practice Address - Country:US
Practice Address - Phone:608-209-7832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-05
Last Update Date:2016-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI42538207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine