Provider Demographics
NPI:1578729752
Name:GREEN, LAKEISHA DEEANN MARSH (MD)
Entity Type:Individual
Prefix:
First Name:LAKEISHA
Middle Name:DEEANN MARSH
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 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-590-8761
Mailing Address - Fax:214-590-1491
Practice Address - Street 1:5200 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7709
Practice Address - Country:US
Practice Address - Phone:469-419-9606
Practice Address - Fax:214-648-9627
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN64732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CL779OtherBCBS
TX215836201Medicaid
TXP00962622OtherRAILROAD MEDICARE
TXTXB110008Medicare PIN