Provider Demographics
NPI:1780618389
Name:GRABOW, ALEEN (MD)
Entity type:Individual
Prefix:
First Name:ALEEN
Middle Name:
Last Name:GRABOW
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 1:715 HILL ST
Mailing Address - Street 2:SUITE # 140
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-3542
Mailing Address - Country:US
Mailing Address - Phone:608-770-3336
Mailing Address - Fax:
Practice Address - Street 1:715 HILL ST
Practice Address - Street 2:SUITE # 140
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-3542
Practice Address - Country:US
Practice Address - Phone:608-770-3336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI370992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32179200Medicaid
WI32179200Medicaid