Organization
GERARDO A. GRIECO, M.D., S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAYLOR GRIECO R.N. (OFFICE MANAGER)
(309) 452-1193
Entity
Organization
Contact information
Practice address
1300 FRANKLIN AVE STE 210, NORMAL, IL 61761-3588
(309) 452-1193
Mailing address
1300 FRANKLIN AVE, SUITE 210, NORMAL, IL 61761-3592
(309) 452-1193
(309) 452-1349
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05715632
BCBS GROUP ID
IL
01
—
DB8294
RR MEDICARE GROUP ID
IL
Enumeration date
04/06/2007
Last updated
03/27/2018
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