Provider Demographics
NPI:1578704482
Name:GREEN, KARL WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:WALTER
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 1:6104 PARADISE POINT DR
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-2607
Mailing Address - Country:US
Mailing Address - Phone:305-255-4888
Mailing Address - Fax:305-252-9881
Practice Address - Street 1:6104 PARADISE POINT DR
Practice Address - Street 2:
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-2607
Practice Address - Country:US
Practice Address - Phone:305-255-4888
Practice Address - Fax:305-252-9881
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME19640207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery