Provider Demographics
NPI:1871624627
Name:GRIENER, THAYNE CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:THAYNE
Middle Name:CHRISTOPHER
Last Name:GRIENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THAYNE
Other - Middle Name:
Other - Last Name:GRIENER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2600 GREENBUSH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2479
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-7625
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI84261-20207Y00000X
AL14670207Y00000X
MS14104207Y00000X
IN01094895A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114214Medicaid
WI1871624627Medicaid