Healthcare Provider Details

I. General information

NPI: 1164412284
Provider Name (Legal Business Name): LEONARD GRECUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 MALABAR RD NE STE 201
PALM BAY FL
32907-2559
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-8531
  • Fax: 321-434-8533
Mailing address:
  • Phone: 321-434-8531
  • Fax: 321-951-7408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME98968
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: