Healthcare Provider Details

I. General information

NPI: 1346202991
Provider Name (Legal Business Name): THERESA A GREBE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E THOMAS RD EAST BUILDING
PHOENIX AZ
85016-7710
US

IV. Provider business mailing address

1919 E THOMAS RD BLDG 2108, STE 101
PHOENIX AZ
85016-7710
US

V. Phone/Fax

Practice location:
  • Phone: 602-546-1000
  • Fax: 602-546-0240
Mailing address:
  • Phone: 602-546-1000
  • Fax: 602-546-0240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number18774
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: