Provider Demographics
NPI:1164640371
Name:STEVEN K. GREKIN, D.O., P.C.
Entity type:Organization
Organization Name:STEVEN K. GREKIN, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:GREKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-759-5525
Mailing Address - Street 1:13450 E 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-3671
Mailing Address - Country:US
Mailing Address - Phone:586-759-5525
Mailing Address - Fax:
Practice Address - Street 1:13450 E 12 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-3671
Practice Address - Country:US
Practice Address - Phone:586-759-5525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI010630207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE82038Medicare UPIN
MI5500344Medicare ID - Type Unspecified