MEDICARE: MR. MICHAEL GREENE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	0700024180	FL

General Provider Information

NPI Number	:	1114041894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL GREENE

Provider Business Mailing Address
First Line	:	4535 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6611
Country	:	US
Telephone Number	:	954-965-3653
Fax Number	:	954-965-3648

Provider Business Practice Location Address
First Line	:	4535 HOLLYWOOD BLVD
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-6611
Country	:	US
Telephone Number	:	954-965-3653
Fax Number	:	954-965-3648

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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Directions to “ MR. MICHAEL GREENE ” Practice Location

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