Individual
THOMAS JOSEPH GREEN III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2001 ALFORD PARK DR, KENOSHA, WI 53140-1994
(574) 910-0586
Mailing address
2001 ALFORD PARK DR, KENOSHA, WI 53140-1994
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/01/2020
Last updated
03/01/2020
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