Provider Demographics
NPI:1164629754
Name:GREEN, HILMA LISA (MD)
Entity Type:Individual
Prefix:DR
First Name:HILMA
Middle Name:LISA
Last Name:GREEN
Suffix:
Gender:F
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:PO BOX 9224
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9224
Mailing Address - Country:US
Mailing Address - Phone:877-848-1457
Mailing Address - Fax:615-465-3017
Practice Address - Street 1:4150 NELSON RD
Practice Address - Street 2:BLDG G, SUITE 7
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4148
Practice Address - Country:US
Practice Address - Phone:337-562-3773
Practice Address - Fax:337-562-3697
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201720207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1018953Medicaid
LA4K8286706Medicare PIN
LA1018953Medicaid