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General NPI Number Information
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NPI Number | 1891788105
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Entity Type | Individual
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Provider Name | MICHAEL A GREENBERG M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/23/2005
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Last Update Date | 09/12/2012
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Provider Practice Location Address
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Address Line | 800 BIESTERFIELD RD STE 3002
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-3364
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Country | US
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Telephone | 847-364-4717
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Fax | 847-364-0191
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Provider Business Mailing Address
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Address Line | 800 BIESTERFIELD RD STE 3002
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-3364
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Country | US
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Telephone | 847-364-4717
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Fax | 847-364-0191
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 036-051235
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 036-051235
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License Number State | IL
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