Provider Demographics
NPI:1295704252
Name:GRUNEIRO, LAURA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
Last Name:GRUNEIRO
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 1:18316 MURDOCK CIRCLE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948
Mailing Address - Country:US
Mailing Address - Phone:941-627-6700
Mailing Address - Fax:941-627-3300
Practice Address - Street 1:18316 MURDOCK CIRCLE
Practice Address - Street 2:SUITE 107
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948
Practice Address - Country:US
Practice Address - Phone:941-627-6700
Practice Address - Fax:941-627-3300
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421313208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001958603Medicaid
H19372Medicare UPIN
PA071988Medicare ID - Type Unspecified