Provider Demographics
NPI:1346202991
Name:GREBE, THERESA A (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:GREBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 E THOMAS RD
Mailing Address - Street 2:BLDG 2108, STE 101
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7710
Mailing Address - Country:US
Mailing Address - Phone:602-546-1000
Mailing Address - Fax:602-546-0240
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:EAST BUILDING
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-546-1000
Practice Address - Fax:602-546-0240
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18774207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ184086Medicaid
AZ184086Medicaid
AZE52291Medicare UPIN