Provider Demographics
NPI:1932423878
Name:BRIAN J GRETEMAN, DPM, PA
Entity Type:Organization
Organization Name:BRIAN J GRETEMAN, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GRETEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:763-422-0233
Mailing Address - Street 1:3883 COON RAPIDS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-2518
Mailing Address - Country:US
Mailing Address - Phone:763-422-0233
Mailing Address - Fax:763-422-9640
Practice Address - Street 1:3883 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-2518
Practice Address - Country:US
Practice Address - Phone:763-422-0233
Practice Address - Fax:763-422-9640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-22
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN435213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN873725800Medicaid
4347890001Medicare NSC
MN873725800Medicaid
480000397Medicare PIN