MEDICARE: DR. CAROLE BRESNAHAN GRIEGO 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	208000000X	Pediatrics Physician	24115	AZ

General Provider Information

NPI Number	:	1811629694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLE BRESNAHAN GRIEGO MD

Provider Business Mailing Address
First Line	:	6134 E INDIAN BEND RD
Second Line	:
City	:	PARADISE VALLEY
State	:	AZ
Zip	:	85253-3440
Country	:	US
Telephone Number	:	480-244-9159
Fax Number	:

Provider Business Practice Location Address
First Line	:	6134 E INDIAN BEND RD
Second Line	:
City	:	PARADISE VALLEY
State	:	AZ
Zip	:	85253-3440
Country	:	US
Telephone Number	:	480-244-9159
Fax Number	:

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

Provider Enumeration Date	:	06/29/2022
Last Update Date	:	06/29/2022

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