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NPI Code Detail

MEDICARE: LEONARD J GREEN MD

MEDICARE: LEONARD J 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
1207Q00000XFamily Medicine Physician01027059AIN

Other Identifiers

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

General Provider Information

NPI Number : 1639299738
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEONARD J GREEN MD
Provider Business Mailing Address
First Line : PO BOX 710
Second Line :
City : PORTLAND
State : IN
Zip : 47371-0710
Country : US
Telephone Number : 260-726-8822
Fax Number : 260-726-7857
Provider Business Practice Location Address
First Line : 428 W VOTAW ST
Second Line : SUITE A
City : PORTLAND
State : IN
Zip : 47371-1302
Country : US
Telephone Number : 260-726-8822
Fax Number : 260-726-7857
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2007
Last Update Date : 11/15/2010

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