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NPI Code Detail

MEDICARE: GREGORY G GREEN MD

MEDICARE: GREGORY G 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
12084P0800XPsychiatry Physician4301074048MI

General Provider Information

NPI Number : 1780673525
Entity Type Code : Individual
Provider Name (Legal Business Name) : GREGORY G GREEN MD
Provider Business Mailing Address
First Line : 376 APPLE AVE
Second Line :
City : MUSKEGON
State : MI
Zip : 49442-3466
Country : US
Telephone Number : 231-724-1111
Fax Number : 231-720-3295
Provider Business Practice Location Address
First Line : 376 APPLE AVE
Second Line : SUITE 307
City : MUSKEGON
State : MI
Zip : 49442-3466
Country : US
Telephone Number : 231-724-1111
Fax Number : 231-720-3295
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/14/2005
Last Update Date : 08/30/2016

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