MEDICARE: JAMES MICHAEL GRUESKIN 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	207P00000X	Emergency Medicine Physician	036-110306	IL
2	207P00000X	Emergency Medicine Physician	A55342	CA
3	207P00000X	Emergency Medicine Physician	M4124	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8AK763	OTHER	TX	BCBSTX
3	1225029424	OTHER	TX	BCBSTX
4	1225029424	OTHER	TX	TRICARE SOUTH
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225029424
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES MICHAEL GRUESKIN MD

Provider Business Mailing Address
First Line	:	14203 HANSONS CREEK CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-4966
Country	:	US
Telephone Number	:	281-225-7030
Fax Number	:

Provider Business Practice Location Address
First Line	:	14203 HANSONS CREEK CT
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77044-4966
Country	:	US
Telephone Number	:	281-225-7030
Fax Number	:

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	11/25/2015

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