Healthcare Provider Details

I. General information

NPI: 1013352137
Provider Name (Legal Business Name): WAKE FOREST HEALTH NETWORK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2013
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4515 PREMIER DR STE 405
HIGH POINT NC
27265-8356
US

IV. Provider business mailing address

4515 PREMIER DR STE 405
HIGH POINT NC
27265-8356
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2105
  • Fax: 336-802-2106
Mailing address:
  • Phone: 336-802-2105
  • Fax: 336-802-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: CRAIG MICHAEL GREVEN
Title or Position: SR VP CLINICAL OPERATIONS
Credential: MD
Phone: 336-716-1331