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General NPI Number Information
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NPI Number | 1164985040
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Entity Type | Individual
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Provider Name | GRETA BIRES MD
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Gender | Female
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Dates
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Enumeration Date | 04/09/2019
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 259 E ERIE ST STE 2150
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City | CHICAGO
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State | IL
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Zip | 60611-3370
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Country | US
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Telephone | 312-926-3627
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Fax | 312-926-3858
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Provider Business Mailing Address
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Address Line | 1 FEDERAL ST STE 200
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City | CAMDEN
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State | NJ
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Zip | 08103-1088
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Country | US
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Telephone | 848-288-6935
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | MD475023
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD475023
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25MA12732100
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 036170447
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License Number State | IL
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