Provider Demographics
NPI:1073501607
Name:GRECO, ALFRED O (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:O
Last Name:GRECO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1418 CROSS ST
Mailing Address - Street 2:DIV IM MEDICAL ONCOLOGY, STE 180
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2988
Mailing Address - Country:US
Mailing Address - Phone:618-607-1340
Mailing Address - Fax:618-622-9724
Practice Address - Street 1:1418 CROSS ST
Practice Address - Street 2:DIV IM MEDICAL ONCOLOGY, STE 180
Practice Address - City:SHILOH
Practice Address - State:IL
Practice Address - Zip Code:62269-2988
Practice Address - Country:US
Practice Address - Phone:618-607-1340
Practice Address - Fax:618-622-9724
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2021-11-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036125100207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201289527Medicaid
MO201289543Medicaid
MO001013483Medicare PIN
MO201289543Medicaid
MO001013482Medicare PIN
A13202Medicare UPIN
MO830007714Medicare PIN