Provider Demographics
NPI:1003834128
Name:GREINER, TERESA J (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:J
Last Name:GREINER
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 1:1175 E 300 N
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-9505
Mailing Address - Country:US
Mailing Address - Phone:701-580-2489
Mailing Address - Fax:
Practice Address - Street 1:3265 INTERTECH DR
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-7325
Practice Address - Country:US
Practice Address - Phone:260-665-9494
Practice Address - Fax:260-665-9496
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND75792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0039746Medicaid
ND20492OtherBLUE SHIELD OF ND
ND18891Medicaid
N715085Medicare PIN
NDE82729Medicare UPIN