Healthcare Provider Details

I. General information

NPI: 1982690269
Provider Name (Legal Business Name): MICHAEL A GREENE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 US HIGHWAY 1
SEBASTIAN FL
32958-4141
US

IV. Provider business mailing address

816 US HIGHWAY 1
SEBASTIAN FL
32958-4141
US

V. Phone/Fax

Practice location:
  • Phone: 772-581-5848
  • Fax: 772-581-5849
Mailing address:
  • Phone: 772-581-5848
  • Fax: 772-581-5849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME65689
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: