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Individual
DR. KENNETH O GREEN
Active
Individual
DR. KENNETH O GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D,
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036037266
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036037266
—
IL
01
—
1376586685
NPI GROUP
IL
01
—
211586
MEDICARE GROUP
IL
01
—
CH6508
MEDICARE RAILROAD GROUP
IL
01
—
P00216102
MEDICARE RAILROAD
IL
Enumeration date
06/22/2005
Last updated
04/13/2009
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