MEDICARE: DR. PAULA B 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	207P00000X	Emergency Medicine Physician	036-102063	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

General Provider Information

NPI Number	:	1609876077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAULA B GREEN M.D.

Provider Business Mailing Address
First Line	:	6344 MAIN STREET
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516
Country	:	US
Telephone Number	:	630-969-8735
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 ERIE CT
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-2519
Country	:	US
Telephone Number	:	708-763-6747
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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