Provider Demographics
NPI:1538320700
Name:GREBLO, ZORISLAV NMN (MD)
Entity Type:Individual
Prefix:
First Name:ZORISLAV
Middle Name:NMN
Last Name:GREBLO
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 1:434 N WESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1324
Mailing Address - Country:US
Mailing Address - Phone:608-833-1408
Mailing Address - Fax:
Practice Address - Street 1:434 N WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1324
Practice Address - Country:US
Practice Address - Phone:608-833-1408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI158560202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry