MEDICARE: DR. ALBERT MICHAEL GREEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	35-050675	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083724397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALBERT MICHAEL GREEN M.D.

Provider Business Mailing Address
First Line	:	1001 LAKESIDE AVE E
Second Line	:	#1200
City	:	CLEVELAND
State	:	OH
Zip	:	44114-1158
Country	:	US
Telephone Number	:	216-479-5541
Fax Number	:	216-479-5554

Provider Business Practice Location Address
First Line	:	2665 HADDAM RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1531
Country	:	US
Telephone Number	:	216-531-5317
Fax Number	:	216-371-8833

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	06/04/2013

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