Organization
LAURI GREEN M.D. S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURI THERESA GREEN M.D. (OWNER)
(262) 695-1212
Entity
Organization
Contact information
Practice address
1177 QUAIL CT, SUITE 101, PEWAUKEE, WI 53072-3790
(262) 695-1212
(262) 695-1919
Mailing address
1177 QUAIL CT, SUITE 101, PEWAUKEE, WI 53072-3790
(262) 695-1212
(262) 695-1919
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
38185
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32265500
—
WI
Enumeration date
07/30/2006
Last updated
08/22/2020
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