Individual
DR. CHARLES JOSEPH GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3400 UNION AVE, SHEBOYGAN, WI 53081-8426
(920) 828-2530
(920) 828-2535
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
5101016991
MI
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
55576021
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100024101
—
WI
Enumeration date
04/13/2007
Last updated
10/11/2023
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