Individual
LEONARD J GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
428 W VOTAW ST, SUITE A, PORTLAND, IN 47371-1302
(260) 726-8822
(260) 726-7857
Mailing address
PO BOX 710, PORTLAND, IN 47371-0710
(260) 726-8822
(260) 726-7857
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01027059A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100253720
—
IN
Enumeration date
03/30/2007
Last updated
11/15/2010
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