MEDICARE: DR. GINA LUISA GRECO-ANGELOPOULOS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	187186	NY
2	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	MD.205378	LA

General Provider Information

NPI Number	:	1073554010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GINA LUISA GRECO-ANGELOPOULOS MD

Provider Business Mailing Address
First Line	:	2640 COUNTRY CLUB RD
Second Line	:	SUITE 400
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2640 COUNTRY CLUB RD
Second Line	:	SUITE 400
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5912
Country	:	US
Telephone Number	:	815-713-2600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	01/17/2013

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