| Charles Grade Md, Llc | |
|
7845 Harwood Ave Wauwatosa WI 53213-2523 | |
| (414) 270-1011 | |
| (414) 270-1031 |
| Full Name | Charles Grade Md, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 7845 Harwood Ave, Wauwatosa, Wisconsin |
| Authorized Official Name and Position | Charles M Grade (PSYCHIATRIST) |
| Authorized Official Contact | 4142701011 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles Grade Md, Llc 7845 Harwood Ave Wauwatosa WI 53213-2523 Ph: (414) 270-1011 | Charles Grade Md, Llc 7845 Harwood Ave Wauwatosa WI 53213-2523 Ph: (414) 270-1011 |
| NPI Number | 1922267483 |
|---|---|
| Provider Enumeration Date | 06/09/2008 |
| Last Update Date | 06/24/2021 |
| Certification Date | 06/24/2021 |
| Medicare PECOS PAC ID | 5294897989 |
|---|---|
| Medicare Enrollment ID | O20081213000237 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922267483 | NPI | - | NPPES |
| 31874500 | Medicaid | WI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 32662 (Wisconsin) | Primary |
| Provider Name | Charles M Grade |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1790890796 PECOS PAC ID: 2668534355 Enrollment ID: I20081213000232 |
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