Provider Demographics
NPI:1700826591
Name:GREIST, THOMAS H (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:GREIST
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-962-4836
Mailing Address - Fax:317-962-8646
Practice Address - Street 1:4880 CENTURY PLAZA RD
Practice Address - Street 2:SUITE 265
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5469
Practice Address - Country:US
Practice Address - Phone:317-216-2700
Practice Address - Fax:317-216-2555
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-10-23
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Provider Licenses
StateLicense IDTaxonomies
IN01026244207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN676050SMedicare PIN
INB28318Medicare UPIN