Provider Demographics
NPI:1528214160
Name:GREEN, JAMES LEITZE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEITZE
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1340 CHARLES ST
Mailing Address - Street 2:STE 400
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104-2200
Mailing Address - Country:US
Mailing Address - Phone:779-475-3711
Mailing Address - Fax:779-429-0891
Practice Address - Street 1:1340 CHARLES ST
Practice Address - Street 2:STE 400
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-2200
Practice Address - Country:US
Practice Address - Phone:779-475-3711
Practice Address - Fax:779-429-0891
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-14
Last Update Date:2017-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036040754207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD89457Medicare UPIN
IL313780Medicaid