Provider Demographics
NPI:1013031384
Name:GRIECO, EMIL RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:EMIL
Middle Name:RICHARD
Last Name:GRIECO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:990 TAMIAMI TRL N
Practice Address - Street 2:SUITE 200
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5403
Practice Address - Country:US
Practice Address - Phone:239-434-6300
Practice Address - Fax:239-434-7174
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME15950208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1193071OtherWELLCARE
FL009985400Medicaid
FL055356500Medicaid
FL5981076OtherAETNA
FLP108077OtherFREEDOM
FL260463OtherAVMED
FL7982717OtherCIGNA
FL10G243OtherHEALTHY KIDS
FL71036OtherBCBS
FLP306911OtherOPTIMUM
FL71036OtherBCBS OF FL
FLP108077OtherFREEDOM HEALTH
FL71036YMedicare PIN
FL260463OtherAVMED
FL71036OtherBCBS
FLP00436129Medicare PIN