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General NPI Number Information
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NPI Number | 1326200692
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Entity Type | Individual
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Provider Name | NICHOLAS AUSTIN GREINER D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 02/01/2024
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Provider Practice Location Address
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Address Line | 15945 CLAYTON RD STE 210
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City | BALLWIN
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State | MO
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Zip | 63011-2491
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Country | US
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Telephone | 368-931-3606
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Fax | 636-893-1362
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Provider Business Mailing Address
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Address Line | PO BOX 776084
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City | CHICAGO
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State | IL
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Zip | 60677-6084
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Country | US
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Telephone | 636-893-1360
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Fax | 636-893-1362
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 2011005769
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License Number State | MO
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