MEDICARE: MR. DAVID GREEN

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	237700000X	Hearing Instrument Specialist	AS5274	FL

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

General Provider Information

NPI Number	:	1235475591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID GREEN

Provider Business Mailing Address
First Line	:	1930 MARTIN RD
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-2035
Country	:	US
Telephone Number	:	248-556-6480
Fax Number	:

Provider Business Practice Location Address
First Line	:	263 US HIGHWAY 27 N
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-2146
Country	:	US
Telephone Number	:	863-385-5656
Fax Number	:

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

Provider Enumeration Date	:	12/13/2012
Last Update Date	:	10/20/2017

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Directions to “ MR. DAVID GREEN ” Practice Location

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