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General NPI Number Information
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NPI Number | 1982830238
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Entity Type | Individual
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Provider Name | JACINTA GREEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/01/2009
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 4425 W 63RD ST STE 204
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City | CHICAGO
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State | IL
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Zip | 60629-5565
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Country | US
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Telephone | 888-876-7012
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Fax |
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Provider Business Mailing Address
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Address Line | 825 WOODLEA RD
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City | KANKAKEE
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State | IL
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Zip | 60901-8199
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Country | US
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Telephone | 815-937-0552
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Fax |
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125:056090
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036.139092
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036.139092
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License Number State | IL
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