Provider Demographics
NPI:1447517495
Name:GREINKE, JESSICA (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GREINKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:STRAFASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8960 COMMERCE DR STE 4E
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:KS
Mailing Address - Zip Code:66018-8431
Mailing Address - Country:US
Mailing Address - Phone:913-789-3961
Mailing Address - Fax:913-583-3667
Practice Address - Street 1:8960 COMMERCE DR STE 4E
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:KS
Practice Address - Zip Code:66018-8431
Practice Address - Country:US
Practice Address - Phone:913-789-3961
Practice Address - Fax:913-583-3667
Is Sole Proprietor?:No
Enumeration Date:2012-04-16
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-38485207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G93000044Medicare PIN