Provider Demographics
NPI:1104025246
Name:MICHAEL E. GREEN
Entity Type:Organization
Organization Name:MICHAEL E. GREEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF BUSINESS
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-452-1602
Mailing Address - Street 1:854 LONE OAK DR
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-3694
Mailing Address - Country:US
Mailing Address - Phone:615-452-1602
Mailing Address - Fax:615-451-0139
Practice Address - Street 1:854 LONE OAK DR
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-3694
Practice Address - Country:US
Practice Address - Phone:615-452-1602
Practice Address - Fax:615-451-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000025545207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2680132003OtherCIGNA COMMERCIAL
TN3083540OtherMEDICARE PROVIDER ID - IN
TNNASH86608OtherPHCS
TN0840119OtherUNITED HEALTH CARE
TN4480107OtherAETNA
TN3373178OtherMEDICARE PROVIDER ID- GRO
TNF88358OtherUPIN
TN3373178Medicaid
TN0191345OtherBLUE CROSS BLUE SHIELD OF