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General NPI Number Information
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NPI Number | 1073838868
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Entity Type | Individual
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Provider Name | LAUREN GREEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/05/2010
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 1740 W TAYLOR ST RADIOLOGY DEPARTMENT 2ND FLOOR
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City | CHICAGO
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State | IL
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Zip | 60612-7232
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Country | US
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Telephone | 312-996-0235
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Fax |
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Provider Business Mailing Address
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Address Line | 299 W 12TH ST APT 3B
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City | NEW YORK
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State | NY
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Zip | 10014-1833
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036.137821
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License Number State | IL
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