Provider Demographics
NPI:1326200692
Name:GREINER, NICHOLAS AUSTIN (DO)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:AUSTIN
Last Name:GREINER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:636-893-1360
Mailing Address - Fax:636-893-1362
Practice Address - Street 1:15945 CLAYTON RD STE 210
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2491
Practice Address - Country:US
Practice Address - Phone:368-931-3606
Practice Address - Fax:636-893-1362
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011005769207QS0010X, 390200000X
MO2008016701207Q00000X
IL125.059091390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program