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General NPI Number Information
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NPI Number | 1912963505
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Entity Type | Organization
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Legal Business Name | GREENE ISABELL MED ASSOC INC
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Dates
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Enumeration Date | 04/24/2006
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Last Update Date | 06/11/2009
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Provider Practice Location Address
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Address Line | 7906 S CRANDON AVE SUITE 1
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City | CHICAGO
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State | IL
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Zip | 60617-1146
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Country | US
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Telephone | 773-734-1577
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Fax | 773-734-1077
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Provider Business Mailing Address
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Address Line | 7906 S CRANDON AVE SUITE 1
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City | CHICAGO
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State | IL
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Zip | 60617-1146
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Country | US
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Telephone | 773-734-1577
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Fax | 773-734-1077
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW BRICE GREENE JR.
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Credential | M.D.
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Telephone | 773-734-1577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036057667
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 036051858
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License Number State | IL
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