Organization
INPATIENT PEDIATRIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MITRA GREEN M.D. (PHYSICIAN)
(318) 387-3453
Entity
Organization
Contact information
Practice address
3421 MEDICAL PARK DR, MONROE, LA 71203-2355
(318) 387-3453
(318) 323-9045
Mailing address
1601 LAMY LN, MONROE, LA 71201-3735
(318) 387-3453
(318) 323-9045
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1449725
—
LA
Enumeration date
07/01/2006
Last updated
07/20/2007
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