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General NPI Number Information
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NPI Number | 1952399313
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Entity Type | Individual
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Provider Name | VLADIMIR ALEXANDROVICH GREBENNIKOV M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/11/2005
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Last Update Date | 07/25/2013
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Provider Practice Location Address
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Address Line | 870 N COIT RD SUITE 2660
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City | RICHARDSON
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State | TX
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Zip | 75080-5420
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Country | US
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Telephone | 972-235-2459
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Fax | 972-235-9435
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Provider Business Mailing Address
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Address Line | 870 N COIT RD SUITE 2660
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City | RICHARDSON
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State | TX
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Zip | 75080-5420
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Country | US
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Telephone | 972-235-2459
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Fax | 972-235-9435
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | K9291
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License Number State | TX
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