Provider Demographics
NPI:1285654616
Name:GREULOCH, KEVIN W (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:W
Last Name:GREULOCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8096
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-3937
Mailing Address - Fax:314-362-6564
Practice Address - Street 1:9890 CLAYTON RD STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1685
Practice Address - Country:US
Practice Address - Phone:314-395-9613
Practice Address - Fax:314-395-9621
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2019-12-10
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Provider Licenses
StateLicense IDTaxonomies
MO2004019684207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO934690103Medicaid
MO934690103Medicaid
MO934690103Medicaid
MOP00388779Medicare PIN