Basic Information
Provider Information
NPI: 1861836280
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GRECO
FirstName: PATRICIA
MiddleName: STEPHANIE
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: SZMAL
OtherFirstName: PATRICIA
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 3621 S STATE ST
Address2: 700 KMS PLACE
City: ANN ARBOR
State: MI
PostalCode: 48108
CountryCode: US
TelephoneNumber: 7349362047
FaxNumber:  
Practice Location
Address1: 8001 CHALLIS ROAD
Address2:  
City: BRIGHTON
State: MI
PostalCode: 481167446
CountryCode: US
TelephoneNumber: 8102279510
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/29/2013
LastUpdateDate: 05/05/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000X4301102580MIY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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