Provider Demographics
NPI:1184671166
Name:GRUENEWALD, RICHARD LOUIS (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:LOUIS
Last Name:GRUENEWALD
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 1:3638 TREEHAVEN BND
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1785
Mailing Address - Country:US
Mailing Address - Phone:270-485-1238
Mailing Address - Fax:
Practice Address - Street 1:3638 TREEHAVEN BND
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1785
Practice Address - Country:US
Practice Address - Phone:270-485-1238
Practice Address - Fax:270-684-4606
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27791207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100024520AMedicaid
KYP01079958OtherRR MEDICARE TROVER
KY000000754876OtherBCBS
KY000000754876OtherBCBS TROVER
KY64277916Medicaid
KY000000754876OtherBCBS TROVER
KYP01079958OtherRR MEDICARE TROVER
KYK034120Medicare PIN
KYK034121Medicare PIN