Provider Demographics
NPI:1619937786
Name:GREER, TODD BLAKE (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:BLAKE
Last Name:GREER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TODD
Other - Middle Name:
Other - Last Name:GREER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2001 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1069
Mailing Address - Country:US
Mailing Address - Phone:630-725-2730
Mailing Address - Fax:844-205-5691
Practice Address - Street 1:2775 OLD MILTON PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-2212
Practice Address - Country:US
Practice Address - Phone:678-781-8201
Practice Address - Fax:678-781-8202
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042261207R00000X, 202K00000X, 2086S0129X
IL0361090012086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G35876Medicare UPIN
GA76BBBBHMedicare PIN