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General NPI Number Information
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NPI Number | 1114243466
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Entity Type | Organization
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Legal Business Name | LAURA A GRUNEIRO MD PA
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Dates
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Enumeration Date | 04/12/2010
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Last Update Date | 04/12/2010
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Provider Practice Location Address
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Address Line | 18316 MURDOCK CIR SUITE 107
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-1008
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Country | US
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Telephone | 507-620-7053
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Fax |
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Provider Business Mailing Address
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Address Line | 18316 MURDOCK CIR SUITE 107
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City | PORT CHARLOTTE
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State | FL
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Zip | 33948-1008
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Country | US
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Telephone | 507-620-7053
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LAURA GRUNEIRO
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Credential | MD
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Telephone | 570-620-7053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | ME86827
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License Number State | FL
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