Healthcare Provider Details

I. General information

NPI: 1487633996
Provider Name (Legal Business Name): STEVEN D GREEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 DANVILLE ST
LANCASTER KY
40444-1150
US

IV. Provider business mailing address

405 DANVILLE ST
LANCASTER KY
40444-1150
US

V. Phone/Fax

Practice location:
  • Phone: 859-792-2124
  • Fax: 859-792-4759
Mailing address:
  • Phone: 859-792-2124
  • Fax: 859-792-4759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number22106
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: