Individual
ERIC R GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
926 S WASHINGTON AVE, HOLLAND, MI 49423-7725
(616) 393-0166
Mailing address
1990 LEISURE BLVD, HOLLAND, MI 49424-9076
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
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