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General NPI Number Information
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NPI Number | 1104006105
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Entity Type | Organization
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Legal Business Name | HENRY L GREEN MD PC
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 07/09/2014
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Provider Practice Location Address
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Address Line | 22255 GREENFIELD SUITE 231
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3728
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Country | US
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Telephone | 248-569-0122
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Fax | 248-569-3758
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Provider Business Mailing Address
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Address Line | 22255 GREENFIELD SUITE 231
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3728
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Country | US
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Telephone | 248-569-0122
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Fax | 248-569-3758
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Authorized Official
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Title or Position | MD/PRESIDENT
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Name | DR. HENRY L GREEN
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Credential | MD
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Telephone | 248-569-0122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 21840
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License Number State | MI
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