Provider Demographics
NPI:1437413978
Name:GREISS, HISHAM (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:HISHAM
Middle Name:
Last Name:GREISS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8635 LEMONT RD
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-4805
Mailing Address - Country:US
Mailing Address - Phone:630-427-0300
Mailing Address - Fax:630-427-0302
Practice Address - Street 1:8635 LEMONT RD
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-4805
Practice Address - Country:US
Practice Address - Phone:630-427-0300
Practice Address - Fax:630-427-0302
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDI41357174400000X, 246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist
No174400000XOther Service ProvidersSpecialist