Provider Demographics
NPI:1659900140
Name:GREEN, MICHELLE LEAR (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEAR
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 1:5844 NW BARRY RD STE 110
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-1483
Mailing Address - Country:US
Mailing Address - Phone:816-880-6100
Mailing Address - Fax:
Practice Address - Street 1:5844 NW BARRY RD STE 110
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64154-1483
Practice Address - Country:US
Practice Address - Phone:816-880-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2023-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-47903207Q00000X
MO2023008317207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine