Provider Demographics
NPI:1689848491
Name:GREEN BAY MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:GREEN BAY MEDICAL CENTER LLC
Other - Org Name:YING G. HENSEL, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER & DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:XIAOYING
Authorized Official - Middle Name:GUO
Authorized Official - Last Name:HENSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-784-5200
Mailing Address - Street 1:615 HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3914
Mailing Address - Country:US
Mailing Address - Phone:847-784-1587
Mailing Address - Fax:847-784-1587
Practice Address - Street 1:310 HAPP RD STE 207
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3457
Practice Address - Country:US
Practice Address - Phone:847-784-5200
Practice Address - Fax:847-784-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098890207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1627087OtherBLUECROSS/BLUESHIELD
IL036098890Medicaid
IL036098890Medicaid
BG6126761OtherFEDERAL DEA NUMBER
IL036098890Medicaid