Provider Demographics
NPI:1225029424
Name:GRUESKIN, JAMES MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:GRUESKIN
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 1:14203 HANSONS CREEK CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-4966
Mailing Address - Country:US
Mailing Address - Phone:281-225-7030
Mailing Address - Fax:
Practice Address - Street 1:14203 HANSONS CREEK CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-4966
Practice Address - Country:US
Practice Address - Phone:281-225-7030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-110306207P00000X
CAA55342207P00000X
TXM4124207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187651803Medicaid
TX8AK763OtherBCBSTX
TX1225029424OtherBCBSTX
TX1225029424OtherTRICARE SOUTH
TX187651802Medicaid
TXP00459907Medicare PIN
TX1225029424OtherBCBSTX
TX1225029424Medicare PIN
TX1225029424OtherTRICARE SOUTH