Provider Demographics
NPI:1841209186
Name:LOUIS GEORGE GRECO MD PC
Entity Type:Organization
Organization Name:LOUIS GEORGE GRECO MD PC
Other - Org Name:GRECO MEDICAL PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-981-9234
Mailing Address - Street 1:55 S 63RD ST STE 6
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1605
Mailing Address - Country:US
Mailing Address - Phone:480-981-9234
Mailing Address - Fax:480-981-3365
Practice Address - Street 1:55 S 63RD ST STE 6
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1605
Practice Address - Country:US
Practice Address - Phone:480-981-9234
Practice Address - Fax:480-981-3038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ110086203OtherRAIL ROAD MEDICARE
AZ110086203OtherRAIL ROAD MEDICARE