Healthcare Provider Details

I. General information

NPI: 1245454222
Provider Name (Legal Business Name): V GREENE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 E 47TH ST
CHICAGO IL
60653-4508
US

IV. Provider business mailing address

80 BURR RIDGE PKWY PMB 144
BURR RIDGE IL
60527-0832
US

V. Phone/Fax

Practice location:
  • Phone: 773-924-1978
  • Fax:
Mailing address:
  • Phone: 708-788-2038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number036089662
License Number StateIL

VIII. Authorized Official

Name: DR. VYBERT P GREENE
Title or Position: PRESIDENT
Credential: MD
Phone: 312-791-2812