Individual
DR. RICHARD GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2203 W 116TH PL, CHICAGO, IL 60643-4735
(773) 445-3933
(773) 445-3935
Mailing address
2203 W 116TH PL, CHICAGO, IL 60643-4735
(773) 445-3933
(773) 445-3935
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036042299
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036042299
—
IL
01
—
1618334
BCBS ID
IL
01
—
P00048214
RAILROAD
IL
Enumeration date
09/13/2006
Last updated
11/20/2014
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