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General NPI Number Information
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NPI Number | 1356915656
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Entity Type | Organization
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Legal Business Name | BRAD K GREENSPAN
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Dates
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Enumeration Date | 05/19/2021
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 480 ELM PL STE 104
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2535
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Country | US
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Telephone | 847-436-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 480 ELM PL STE 104
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2535
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Country | US
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Telephone | 847-436-1300
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Fax |
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Authorized Official
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Title or Position | ENROLLMENT MANAGER
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Name | SHIRLEY ROLL
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Credential |
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Telephone | 317-472-7396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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