Individual
MRS. DOROTHEA JEAN GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5511 HAMMERSMITH DR, WEST BLOOMFIELD, MI 48322-1455
(248) 788-3426
Mailing address
5511 HAMMERSMITH DR, WEST BLOOMFIELD, MI 48322-1455
(248) 788-3426
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
L1610148
MI
363A00000X
Physician Assistant
Primary
PERMANENT5601001159
MI
Other
Enumeration date
01/06/2011
Last updated
01/06/2011
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