Provider Demographics
NPI:1053320390
Name:GRECO, LOUIS G (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:G
Last Name:GRECO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 S 63RD ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1605
Mailing Address - Country:US
Mailing Address - Phone:480-981-9234
Mailing Address - Fax:480-981-3038
Practice Address - Street 1:55 S 63RD ST STE 6
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1605
Practice Address - Country:US
Practice Address - Phone:480-981-9234
Practice Address - Fax:480-981-3038
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12145207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0038380OtherBCBS AZ PROVIDER NUMBER
AZ110086203OtherRAILROAD PROV NUMBER
AZAZ5313OtherHEALTHNET PROV NUMBER
AZ224494Medicaid
AZD36947Medicare UPIN
AZ110086203OtherRAILROAD PROV NUMBER
AZAZ0038380OtherBCBS AZ PROVIDER NUMBER