University of Wisconsin Medical Foundation

NPI #1225150709 in Rockford, Illinois

Provider Information

NPI Number: 1225150709
Entity Type: Organization
Organization Name: University of Wisconsin Medical Foundation
Primary Specialty: Ophthalmology
Enumeration Date: Apr 4, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 345 EXECUTIVE PKWY
Address 2: SUITE M4
City: Rockford
State: Illinois
ZIP Code: 61107-5340
Phone: (815) 399-1141

Authorized Official

Name: DR. JEFFREY GROSSMAN, MD
Title: PRESIDENT AND CEO
Phone: (815) 399-1141

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Ophthalmology	207W00000X	Primary

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