Provider Demographics
NPI:1003901323
Name:GREENSTONE, CLINTON LEOPOLD (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:LEOPOLD
Last Name:GREENSTONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CLINTONN
Other - Middle Name:LEOPOLD
Other - Last Name:LINDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3621 S STATE ST
Mailing Address - Street 2:700 KMS PLACE
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-936-2047
Mailing Address - Fax:
Practice Address - Street 1:1500 EAST MEDICAL CENTER DR
Practice Address - Street 2:3RD FLOOR TAUBMAN RECP B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5352
Practice Address - Country:US
Practice Address - Phone:734-936-5582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064535207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4859583Medicaid
MI0H17613786Medicare ID - Type Unspecified
MI4859583Medicaid
MIE46718Medicare UPIN