Provider Demographics
NPI:1922007566
Name:GRIEB, ROLAND A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:A
Last Name:GRIEB
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 1:2827 HARRISON WOODS RD
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47805-8602
Mailing Address - Country:US
Mailing Address - Phone:812-466-2440
Mailing Address - Fax:
Practice Address - Street 1:2827 HARRISON WOODS RD
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47805-8602
Practice Address - Country:US
Practice Address - Phone:812-466-2440
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060843A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology