Provider Demographics
NPI:1053304170
Name:GREENLEE, JEREMY D (MD)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:D
Last Name:GREENLEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-2771
Mailing Address - Fax:319-353-6605
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-2771
Practice Address - Fax:319-353-6605
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA35669207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0439570Medicaid
IA36451OtherWELLMARK BCBS
IA36451OtherWELLMARK BCBS
I07651Medicare UPIN
IAI12639Medicare PIN