MEDICARE: DR. ROBERT F GREEN DPM

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	213E00000X	Podiatrist	1982	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932298155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT F GREEN DPM

Provider Business Mailing Address
First Line	:	PO BOX 527
Second Line	:
City	:	NORTHFIELD
State	:	OH
Zip	:	44067-0527
Country	:	US
Telephone Number	:	330-467-3902
Fax Number	:

Provider Business Practice Location Address
First Line	:	38600 CENTER RIDGE RD
Second Line	:
City	:	N RIDGEVILLE
State	:	OH
Zip	:	44039-2837
Country	:	US
Telephone Number	:	330-467-3902
Fax Number	:

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/09/2007

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