Healthcare Provider Details

I. General information

NPI: 1225292402
Provider Name (Legal Business Name): SIRI ATMA W GREELEY MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2008
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5839 S MARYLAND AVE MC5053
CHICAGO IL
60637-1463
US

IV. Provider business mailing address

5839 S MARYLAND AVE MC5053
CHICAGO IL
60637-1463
US

V. Phone/Fax

Practice location:
  • Phone: 773-702-6432
  • Fax: 773-702-0443
Mailing address:
  • Phone: 773-702-6432
  • Fax: 773-702-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number036-115928
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: