Provider Demographics
NPI:1891788105
Name:GREENBERG, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BIESTERFIELD RD
Mailing Address - Street 2:STE 3002
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3364
Mailing Address - Country:US
Mailing Address - Phone:847-364-4717
Mailing Address - Fax:847-364-0191
Practice Address - Street 1:800 BIESTERFIELD RD
Practice Address - Street 2:STE 3002
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3364
Practice Address - Country:US
Practice Address - Phone:847-364-4717
Practice Address - Fax:847-364-0191
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-051235207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL791073085OtherRAILROAD MEDICARE
IL21607262OtherBLUE CROSS BLUE SHIELD
IL791073085OtherRAILROAD MEDICARE
ILK29802Medicare PIN
ILD89286Medicare UPIN