Provider Demographics
NPI:1972730059
Name:GREEN, JILL C (MD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:C
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 W ROCKLAND RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2700
Mailing Address - Country:US
Mailing Address - Phone:847-881-6858
Mailing Address - Fax:
Practice Address - Street 1:114 W ROCKLAND RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2700
Practice Address - Country:US
Practice Address - Phone:847-881-6858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.056151207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine