MEDICARE: DR. VYBERT P GREENE 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	036-089662	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	:	1942347141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VYBERT P GREENE MD

Provider Business Mailing Address
First Line	:	15774 S LA GRANGE RD # 397
Second Line	:
City	:	ORLAND PARK
State	:	IL
Zip	:	60462-4766
Country	:	US
Telephone Number	:	708-873-1533
Fax Number	:	708-873-1534

Provider Business Practice Location Address
First Line	:	2555 S KING DRIVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-2419
Country	:	US
Telephone Number	:	312-674-4000
Fax Number	:	312-674-4001

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	10/22/2009

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