Provider Demographics
NPI:1952480550
Name:GRECULA, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:GRECULA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 LAUREL STREET
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707
Mailing Address - Country:US
Mailing Address - Phone:409-838-0346
Mailing Address - Fax:409-839-3720
Practice Address - Street 1:3650 LAUREL STREET
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707
Practice Address - Country:US
Practice Address - Phone:409-838-0346
Practice Address - Fax:409-839-3720
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5336207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BE152OtherBCBS OF TEXAS
TX129736806Medicaid
TX129736807OtherCSHCN
TX129736802Medicaid
TX83280NMedicare ID - Type Unspecified
TX129736807OtherCSHCN
TX129736802Medicaid