Healthcare Provider Details

I. General information

NPI: 1891788105
Provider Name (Legal Business Name): MICHAEL A GREENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BIESTERFIELD RD STE 3002
ELK GROVE VILLAGE IL
60007-3364
US

IV. Provider business mailing address

800 BIESTERFIELD RD STE 3002
ELK GROVE VILLAGE IL
60007-3364
US

V. Phone/Fax

Practice location:
  • Phone: 847-364-4717
  • Fax: 847-364-0191
Mailing address:
  • Phone: 847-364-4717
  • Fax: 847-364-0191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036-051235
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number036-051235
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: