Individual
ALISE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1402 E COUNTY LINE RD, INDIANAPOLIS, IN 46227-0963
(317) 887-7000
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-9312
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01080421A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300015712
—
IN
Enumeration date
05/28/2015
Last updated
09/24/2021
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