Provider Demographics
NPI:1922462811
Name:GREEN PEDIATRICS LLC
Entity Type:Organization
Organization Name:GREEN PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BILJANA
Authorized Official - Middle Name:
Authorized Official - Last Name:UZELAC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-662-3931
Mailing Address - Street 1:PO BOX 1153
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46308-1153
Mailing Address - Country:US
Mailing Address - Phone:219-662-3931
Mailing Address - Fax:
Practice Address - Street 1:8247 WICKER AVE
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-8878
Practice Address - Country:US
Practice Address - Phone:219-662-3931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-07
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064437A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201361020AMedicaid