Healthcare Provider Details

I. General information

NPI: 1407849938
Provider Name (Legal Business Name): SARAH A GREEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2005
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 CRAWFORD AVENUE
OLYMPIA FIELDS IL
60461
US

IV. Provider business mailing address

4535 DRESSLER ROAD NW
CANTON OH
44718
US

V. Phone/Fax

Practice location:
  • Phone: 708-747-4000
  • Fax: 866-520-0761
Mailing address:
  • Phone: 330-493-4443
  • Fax: 330-493-8677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02002724A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: