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General NPI Number Information
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NPI Number | 1689975609
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Entity Type | Organization
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Legal Business Name | ALLISON GREEN PLLC
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Dates
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Enumeration Date | 11/08/2010
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 7656 BEEBALM CT
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City | DEXTER
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State | MI
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Zip | 48130-9336
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Country | US
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Telephone | 734-434-3545
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Fax |
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Provider Business Mailing Address
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Address Line | 7656 BEEBALM CT
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City | DEXTER
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State | MI
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Zip | 48130-9336
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Country | US
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Telephone | 734-434-3545
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALLISON GREEN
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Credential | OTR
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Telephone | 734-545-0027
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 5201003689
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License Number State | MI
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