Healthcare Provider Details

I. General information

NPI: 1184935256
Provider Name (Legal Business Name): JULIE ANN GREEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE SCHWARTZ

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 08/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3265 NE RALPH POWELL RD
LEES SUMMIT MO
64064-2301
US

IV. Provider business mailing address

11550 GRANADA ST
LEAWOOD KS
66211-1453
US

V. Phone/Fax

Practice location:
  • Phone: 913-451-7546
  • Fax: 816-524-4929
Mailing address:
  • Phone: 913-451-7546
  • Fax: 913-663-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2010017730
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: