Provider Demographics
NPI:1760667026
Name:SUSAN K GRENZ MD PA
Entity Type:Organization
Organization Name:SUSAN K GRENZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:GRENZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-733-6633
Mailing Address - Street 1:1964 B BAYSHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698
Mailing Address - Country:US
Mailing Address - Phone:727-733-6633
Mailing Address - Fax:727-738-8194
Practice Address - Street 1:1964 B BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698
Practice Address - Country:US
Practice Address - Phone:727-733-6633
Practice Address - Fax:727-738-8194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3000067OtherBAYCARE
FL62527OtherBCBS
102600OtherAUMED
FL622728OtherAETNA
123062OtherHUMANA
123063OtherHUMANA GOLD
3386236 002OtherCIGNA
FL62527OtherBCBS
=========OtherUNITED HEALTH CARE
FLK6140Medicare PIN