Individual
ALYSIA L GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
633 EMERSON ST, EVANSTON, IL 60208-1394
(847) 491-8100
(847) 491-5919
Mailing address
801 ALBANY ST, FL G, BOSTON, MA 02119-3791
(617) 414-6034
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
036171538
IL
207QS0010X
Sports Medicine (Family Medicine) Physician
232853
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110076162A
—
MA
Enumeration date
05/17/2007
Last updated
09/12/2024
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