Provider Demographics
NPI:1013989870
Name:GRENZ, SUSAN K (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:K
Last Name:GRENZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:779 VIA LOS ALTOS UNIT C
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-4828
Mailing Address - Country:US
Mailing Address - Phone:727-798-6640
Mailing Address - Fax:
Practice Address - Street 1:779 C VIA LOS ALTOS
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637
Practice Address - Country:US
Practice Address - Phone:727-798-6640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18697207R00000X
ND12279207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
102600OtherAUMED
123062OtherHUMANA
3000067OtherBAYCARE
622728OtherAETNA
3386236002OtherCIGNA
123063OtherHUMANA GOLD
62527OtherBCBS
592712571OtherUNITED HEALTH CARE
592712571OtherUNITED HEALTH CARE
622728OtherAETNA