Provider Demographics
NPI:1598709560
Name:GREENMAN, JOHN J (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:GREENMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:JACOB
Other - Last Name:GREENMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:117 S. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-9998
Mailing Address - Country:US
Mailing Address - Phone:260-824-9265
Mailing Address - Fax:260-824-9267
Practice Address - Street 1:117 S. MAIN ST
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-9998
Practice Address - Country:US
Practice Address - Phone:260-824-9265
Practice Address - Fax:260-824-9267
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034958A207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100101710AMedicaid
INE34165Medicare UPIN
IN911080DDDMedicare PIN
E34165Medicare UPIN