Organization
GREENE ISABELL MED ASSOC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW BRICE GREENE JR. M.D. (PRESIDENT)
(773) 734-1577
Entity
Organization
Contact information
Practice address
7906 S CRANDON AVE, SUITE 1, CHICAGO, IL 60617-1146
(773) 734-1577
(773) 734-1077
Mailing address
7906 S CRANDON AVE, SUITE 1, CHICAGO, IL 60617-1146
(773) 734-1577
(773) 734-1077
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
036057667
IL
207RP1001X
Pulmonary Disease Physician
Primary
036051858
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209520
MEDICARE GROUP PROVIDER
IL
Enumeration date
04/24/2006
Last updated
06/11/2009
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