Provider Demographics
NPI:1710979919
Name:GREENLEE, EMILY C (MD)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:C
Last Name:GREENLEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:I
Other - Last Name:CHUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-3938
Mailing Address - Fax:319-353-7699
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-3938
Practice Address - Fax:319-353-7699
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA34554207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA46909OtherWELLMARK BCBS
IA0264895Medicaid
IA0264895Medicaid
IA180044579Medicare PIN
IA46909OtherWELLMARK BCBS
IAI6282Medicare PIN