Provider Demographics
NPI:1942347141
Name:GREENE, VYBERT P (MD)
Entity Type:Individual
Prefix:DR
First Name:VYBERT
Middle Name:P
Last Name:GREENE
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 1:15774 S LA GRANGE RD # 397
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4766
Mailing Address - Country:US
Mailing Address - Phone:708-873-1533
Mailing Address - Fax:708-873-1534
Practice Address - Street 1:2555 S KING DRIVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2419
Practice Address - Country:US
Practice Address - Phone:312-674-4000
Practice Address - Fax:312-674-4001
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-089662207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089662Medicaid
IL208965Medicare UPIN