Charles Grade MD, LLC
Clinic/Center, Adult Mental Health in Wauwatosa, WI. Organization (NPI-2).
NPI number1922267483
StatusActive
Last updated in NPPESJun 24, 2021
Details
- NPI
- 1922267483
- Entity type
- Organization (NPI-2)
- Legal business name
- Charles Grade MD, LLC
- Organization subpart
- No
- Enumeration date
- Jun 9, 2008
- Certification date
- Jun 24, 2021
- Last updated
- Jun 24, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0850X | Clinic/Center, Adult Mental Health | 32662 | WI | Yes |
Practice location
7845 Harwood AveWauwatosa, WI 53213-2523
Phone 414-270-1011 · Fax 414-270-1031
Mailing address
7845 Harwood AveWauwatosa, WI 53213-2523
Phone 414-270-1011 · Fax 414-270-1031
Authorized official
Charles M Grade
Psychiatrist
4142701011
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