Provider Demographics
NPI:1154322790
Name:GREEN, JAMES L (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 166516
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-6516
Mailing Address - Country:US
Mailing Address - Phone:312-567-2795
Mailing Address - Fax:312-567-2783
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:8TH FLOOR EYE CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-567-2795
Practice Address - Fax:312-567-2783
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2017-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL03656121207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036056121Medicaid
ILK50466Medicare PIN
ILD13385Medicare UPIN