Provider Demographics
NPI:1902041197
Name:GRIEBELER, MARCIO LONGHI (MD)
Entity Type:Individual
Prefix:
First Name:MARCIO
Middle Name:LONGHI
Last Name:GRIEBELER
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:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:605-328-6585
Mailing Address - Fax:
Practice Address - Street 1:1305 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0401
Practice Address - Country:US
Practice Address - Phone:605-328-8700
Practice Address - Fax:605-328-8701
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN-10869207R00000X
MN105575207RE0101X
MN54495207RE0101X
SD8961207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP01244580OtherRAILROAD MEDICARE
IAENROLLEDMedicaid
MNENROLLEDMedicaid
WIENROLLEDMedicaid
WIENROLLEDMedicaid