Provider Demographics
NPI:1033441001
Name:ALEJANDRO J. GRUNEIRO M.D. P.A.
Entity Type:Organization
Organization Name:ALEJANDRO J. GRUNEIRO M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRUNEIRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-625-3411
Mailing Address - Street 1:18308 MURDOCK CIR
Mailing Address - Street 2:109
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1008
Mailing Address - Country:US
Mailing Address - Phone:941-625-3411
Mailing Address - Fax:941-625-1792
Practice Address - Street 1:18308 MURDOCK CIR
Practice Address - Street 2:109
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1008
Practice Address - Country:US
Practice Address - Phone:941-625-3411
Practice Address - Fax:941-625-1792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97870174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277603100Medicaid
FLH90792Medicare UPIN
FLAD9337Medicare PIN