Healthcare Provider Details

I. General information

NPI: 1164629754
Provider Name (Legal Business Name): HILMA LISA GREEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 NELSON RD BLDG G, SUITE 7
LAKE CHARLES LA
70605-4148
US

IV. Provider business mailing address

PO BOX 9224
BELFAST ME
04915-9224
US

V. Phone/Fax

Practice location:
  • Phone: 337-562-3773
  • Fax: 337-562-3697
Mailing address:
  • Phone: 877-848-1457
  • Fax: 615-465-3017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.201720
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.201720
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: