Individual
JOHN P GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
200 N PARK ST, KALAMAZOO, MI 49007-3731
(269) 373-7468
(269) 373-0123
Mailing address
601 JOHN ST, BOX 42, KALAMAZOO, MI 49007-5341
(269) 341-7806
(269) 341-8743
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601005131
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0C91143
BCBSM
MI
Enumeration date
11/15/2007
Last updated
09/29/2009
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