Provider Demographics
NPI:1326231077
Name:GRIECO, MICHAEL H (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:GRIECO
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 1:400 SEASAGE DR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-6785
Mailing Address - Country:US
Mailing Address - Phone:561-330-7114
Mailing Address - Fax:561-276-4102
Practice Address - Street 1:400 SEASAGE DR
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-6785
Practice Address - Country:US
Practice Address - Phone:561-330-7114
Practice Address - Fax:561-276-4102
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME22765207R00000X
NJMA19709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C07458Medicare UPIN
26306Medicare PIN