Provider Demographics
NPI:1285637181
Name:GREEN, DANIEL JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:GREEN
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 1:48 S GREENLEAF ST
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3300
Mailing Address - Country:US
Mailing Address - Phone:847-668-4016
Mailing Address - Fax:847-662-4174
Practice Address - Street 1:48 S GREENLEAF ST
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3300
Practice Address - Country:US
Practice Address - Phone:847-668-4016
Practice Address - Fax:847-662-4174
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF10618Medicare UPIN
IL614160Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER