MEDICARE: MARLENE O GREEN MD

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		IL

General Provider Information

NPI Number	:	1437323631
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARLENE O GREEN MD

Provider Business Mailing Address
First Line	:	5478 S GREENWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-5104
Country	:	US
Telephone Number	:	773-230-8582
Fax Number	:

Provider Business Practice Location Address
First Line	:	5478 S GREENWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-5104
Country	:	US
Telephone Number	:	773-230-8582
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARLENE OPAL GREEN
Credential	:	M.D.
Telephone Number	:	773-230-8582

Provider Enumeration Date	:	04/17/2008
Last Update Date	:	04/17/2008

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