Healthcare Provider Details

I. General information

NPI: 1528003043
Provider Name (Legal Business Name): DMITRY A. GREBENEV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13117 66TH ST
LARGO FL
33773-1812
US

IV. Provider business mailing address

13117 66TH ST
LARGO FL
33773-1812
US

V. Phone/Fax

Practice location:
  • Phone: 727-516-8482
  • Fax: 727-516-8483
Mailing address:
  • Phone: 727-516-8482
  • Fax: 727-816-8483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME84211
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: