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Individual

THOMAS E. GREEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
20201 CRAWFORD AVENUE, OLYMPIA FIELDS, IL 60461
(708) 747-4000
(866) 520-0761
Mailing address
4535 DRESSLER ROAD NW, CANTON, OH 44718
(330) 493-4443
(330) 493-8677

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02002714A
IN
207P00000X
Emergency Medicine Physician
036110102
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200401690
IN
01
90001358
BSBSIL
IL
Enumeration date
09/02/2005
Last updated
04/01/2009
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