Individual
CHARLES R GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1937 M 119, PETOSKEY, MI 49770-8913
(231) 348-9200
Mailing address
1937 M 119, PETOSKEY, MI 49770-8913
(231) 348-9200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601003793
MI
Other
Enumeration date
11/14/2006
Last updated
01/05/2009
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