Healthcare Provider Details

I. General information

NPI: 1194838581
Provider Name (Legal Business Name): JOEL S GREENBERG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7335 WESTSHIRE DR STE 102
LANSING MI
48917-9703
US

IV. Provider business mailing address

804 SERVICE RD STE A109B
EAST LANSING MI
48824-7015
US

V. Phone/Fax

Practice location:
  • Phone: 517-622-1012
  • Fax: 517-622-1033
Mailing address:
  • Phone: 517-622-1012
  • Fax: 617-622-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101010629
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: