Provider Demographics
NPI:1598772071
Name:GREENSTEIN, ROSS (PA)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:GREENSTEIN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1885 WESTBOURNE CT
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-9173
Mailing Address - Country:US
Mailing Address - Phone:517-740-2241
Mailing Address - Fax:
Practice Address - Street 1:610 N MICHIGAN ST STE 306
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1079
Practice Address - Country:US
Practice Address - Phone:574-647-6500
Practice Address - Fax:574-647-6518
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005214363A00000X, 363AS0400X
IL085002270363AS0400X
IN10003974A363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK18481Medicare ID - Type Unspecified
ILP87132Medicare UPIN