Douglas C Gremban, MD
Individual provider Active NPI Family Medicine Physician · Mountain, WI
NPI 1316940927 · NPPES record last updated Sep 2, 2014
Key facts
- NPI
- 1316940927
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 23967-020 (WI)
- Practice address
- 14353 State Highway 32 64
Mountain, WI 54149-9656 - Phone
- (715) 276-1600
- Fax
- (715) 276-1800
- NPI assigned
- May 27, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23967-020 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Clare Memorial Hospital, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 23967-020 | WI | Yes |
Addresses
Primary practice location
14353 State Highway 32 64
Mountain, WI 54149-9656
Mailing address
14353 State Highway 32 64
Mountain, WI 54149-9656
Phone (715) 276-1600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11014110 | Medicaid | WI | |
| 1568552958 | Other | WI | MPCC NPI |
| 1851477913 | Other | WI | CMH NPI |
Other providers in Mountain, WI
- CMH Mountain Primary Care Clinic
- CMH Primary Care Clinic Moutain-Physician Dispensary
- Community Memorial Hospital
- St Clare Memorial Hospital, Inc
- St Vincent Hospital-Hospital Sisters-Third Order of St Francis
- Townships of Doty Riverview Mountain Ambulance Service
- Mikaela Gloria Vollmar
All providers in Mountain, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.