MEDICARE: V GREENE MD PC

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	207VX0000X	Obstetrics Physician	036089662	IL

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	1942347141	OTHER	IL	NPI

General Provider Information

NPI Number	:	1245454222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	V GREENE MD PC

Provider Business Mailing Address
First Line	:	80 BURR RIDGE PKWY
Second Line	:	PMB 144
City	:	BURR RIDGE
State	:	IL
Zip	:	60527-0832
Country	:	US
Telephone Number	:	708-788-2038
Fax Number	:

Provider Business Practice Location Address
First Line	:	1322 E 47TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60653-4508
Country	:	US
Telephone Number	:	773-924-1978
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VYBERT P GREENE
Credential	:	MD
Telephone Number	:	312-791-2812

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	01/20/2009

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