Individual
MR. JAMES EDWARD GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AA, PA
Contact information
Practice address
3333 EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9493
(616) 364-4200
(616) 364-7347
Mailing address
3333 EVERGREEN DR NE, GRAND RAPIDS, MI 49525-9493
(616) 364-4200
(616) 364-7347
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5601001816
MI
367H00000X
Anesthesiologist Assistant
Primary
263
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598712390
GROUP NPI
MI
01
—
M73860-008
MEDICARE
MI
01
—
P00343185
RAILROAD MEDICARE PIN
MI
Enumeration date
08/16/2006
Last updated
03/04/2013
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