Provider Demographics
NPI:1982194338
Name:GREEN CROSS MEDICAL CENTER PC
Entity Type:Organization
Organization Name:GREEN CROSS MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:EMILIA
Authorized Official - Middle Name:SANTOS
Authorized Official - Last Name:QUIZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-563-8471
Mailing Address - Street 1:18041 GREENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-3120
Mailing Address - Country:US
Mailing Address - Phone:313-837-0072
Mailing Address - Fax:313-837-0003
Practice Address - Street 1:18041 GREENFIELD RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-3120
Practice Address - Country:US
Practice Address - Phone:313-837-0072
Practice Address - Fax:313-837-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033614207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7039547Medicaid