MEDICARE: DR. MICHAEL H GRIECO 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	207R00000X	Internal Medicine Physician	ME22765	FL
2	207R00000X	Internal Medicine Physician	MA19709	NJ

General Provider Information

NPI Number	:	1326231077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL H GRIECO MD

Provider Business Mailing Address
First Line	:	400 SEASAGE DR
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-6785
Country	:	US
Telephone Number	:	561-330-7114
Fax Number	:	561-276-4102

Provider Business Practice Location Address
First Line	:	400 SEASAGE DR
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-6785
Country	:	US
Telephone Number	:	561-330-7114
Fax Number	:	561-276-4102

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

Provider Enumeration Date	:	08/24/2007
Last Update Date	:	08/30/2010

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