Individual
DR. JACINTA GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4425 W 63RD ST STE 204, CHICAGO, IL 60629-5565
(888) 876-7012
Mailing address
825 WOODLEA RD, KANKAKEE, IL 60901-8199
(815) 937-0552
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036.139092
IL
207R00000X
Internal Medicine Physician
125:056090
IL
207RC0000X
Cardiovascular Disease Physician
036.139092
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036139092
—
IL
Enumeration date
06/01/2009
Last updated
05/29/2025
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