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NPI Code Detail

MEDICARE: DR. ADAM S GREEN MD

MEDICARE: DR. ADAM S 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
12085R0202XDiagnostic Radiology PhysicianDR.0063552CO
22085R0202XDiagnostic Radiology PhysicianME92386FL

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 : 1649226804
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ADAM S GREEN MD
Provider Business Mailing Address
First Line : 11995 SINGLETREE LN STE 500
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55344-5349
Country : US
Telephone Number : 952-595-1301
Fax Number : 612-294-4903
Provider Business Practice Location Address
First Line : 17 DAVIS BLVD STE 308
Second Line :
City : TAMPA
State : FL
Zip : 33606-3438
Country : US
Telephone Number : 813-250-2506
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2006
Last Update Date : 04/29/2024

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