Healthcare Provider Details

I. General information

NPI: 1518171107
Provider Name (Legal Business Name): RYAN B GREENE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/28/2024
Certification Date: 07/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9998 CROSSPOINT BLVD STE 200
INDIANAPOLIS IN
46256-3307
US

IV. Provider business mailing address

121 S SAINT LOUIS BLVD
SOUTH BEND IN
46617-2924
US

V. Phone/Fax

Practice location:
  • Phone: 317-806-8260
  • Fax: 317-806-8296
Mailing address:
  • Phone: 574-233-3123
  • Fax: 574-233-3125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01070846A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number01070846A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: