Individual
ERIC R GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
4301080025
MI
208000000X
Pediatrics Physician
Primary
4301080025
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4301080025
PHYSICIAN LICENSE
MI
05
—
4409089 TYPE 10
—
MI
01
—
5315010080
BOARD OF PHARMACY
MI
Enumeration date
02/13/2006
Last updated
03/07/2023
Update your record
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