Individual
DR. CHARLENE M GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1010 OLIVE AVE, FLORENCE, WI 54121-0380
(715) 528-4775
(715) 528-5592
Mailing address
PO BOX 549, IRON MOUNTAIN, MI 49801-0549
(906) 774-1313
(906) 776-5639
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
42172
WI
207Q00000X
Family Medicine Physician
5101009102
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0852200084
BCBS MI
MI
05
—
30096600
—
WI
05
—
4197165
—
MI
01
—
P00933500
RR MEDICARE
MI
Enumeration date
11/17/2005
Last updated
05/06/2019
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