Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | .017408 | LA |
NPI | 1093793556 |
---|---|
Provider Name | Dr. Michael C Grieb |
First Address | San Antonio, TX 78229-5907 |
Second Address | Metairie, LA 70006-2970 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2006 |
Last Update Date | 11/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1360872 | (05) | LA |
H4048 | BCBS (01) | LA |