Healthcare Provider Details

I. General information

NPI: 1770542862
Provider Name (Legal Business Name): THOMAS PATRICK GREEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CHILDRENS PLAZA CHILDRENS MEMORIAL HOSPITAL
CHICAGO IL
60614
US

IV. Provider business mailing address

2400 CHILDRENS PLAZA BOX #86 CHILDRENS MEMORIAL HOSPITAL
CHICAGO IL
60614
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-4599
  • Fax:
Mailing address:
  • Phone: 773-880-4599
  • Fax: 773-880-3067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: