Provider Demographics
NPI:1467483024
Name:GREINER, MARY ALICE (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ALICE
Last Name:GREINER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6276 JACKSON RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9579
Mailing Address - Country:US
Mailing Address - Phone:734-822-6001
Mailing Address - Fax:734-822-6003
Practice Address - Street 1:6276 JACKSON RD
Practice Address - Street 2:SUITE K
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9579
Practice Address - Country:US
Practice Address - Phone:734-822-6001
Practice Address - Fax:734-822-6003
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101013078207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIM50940025Medicare ID - Type UnspecifiedWA FOOTE MEMORIAL
MION44900Medicare ID - Type UnspecifiedSOLO PRACTICE MEDICARE #
H18922Medicare UPIN