Individual
THELMA LYNETTE GREEN-MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3850 SHORE DRIVE, SUIOTE 305, INDIANAPOLIS, IN 46254-5621
(317) 920-3220
(317) 920-3221
Mailing address
3850 SHORE DRIVE, SUIOTE 305, INDIANAPOLIS, IN 46254-5621
(317) 920-3220
(317) 920-3221
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
01037601
IN
208100000X
Physical Medicine & Rehabilitation Physician
01037601B
IN
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
01037601
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000092241
ANTHEM BCBS
IN
05
—
100130200
—
IN
01
—
1841358017
NPI
IN
01
—
250010985
RAILROAD MEDICARE
IN
Enumeration date
12/04/2006
Last updated
03/09/2023
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