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Organization
RANDALL W. GREEN MD PC
Active
Organization
RANDALL W. GREEN MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL WILLIAM GREEN MD (PRESIDENT)
(616) 774-8200
Entity
Organization
Contact information
Practice address
4070 LAKE DR SE STE 201, GRAND RAPIDS, MI 49546-8294
(616) 774-8200
(616) 774-0304
Mailing address
4070 LAKE DR SE STE 201, GRAND RAPIDS, MI 49546-8294
(616) 774-8200
(616) 774-0304
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073594
—
MI
Enumeration date
06/09/2010
Last updated
06/09/2010
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