Provider Demographics
NPI:1255325791
Name:GREEN, ANDREW J (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:J
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:7450 KESSLER ST STE 203
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2553
Mailing Address - Country:US
Mailing Address - Phone:913-676-7585
Mailing Address - Fax:913-676-8189
Practice Address - Street 1:7450 KESSLER ST STE 203
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2553
Practice Address - Country:US
Practice Address - Phone:913-676-7585
Practice Address - Fax:913-676-8189
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2022-06-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS23873207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS460000031OtherRAILROAD MEDICARE
MO18081015OtherBLUE CROSS BLUE SHIELD
MO18081015OtherBLUE CROSS BLUE SHIELD