Provider Demographics
NPI:1245296284
Name:GREENE, ANDREW BRICE JR (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:BRICE
Last Name:GREENE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8751 S GREENWOOD AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-7051
Mailing Address - Country:US
Mailing Address - Phone:773-734-1577
Mailing Address - Fax:773-734-1077
Practice Address - Street 1:8751 S GREENWOOD AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-7051
Practice Address - Country:US
Practice Address - Phone:773-734-1577
Practice Address - Fax:773-734-1077
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD93839Medicare UPIN
ILK08407Medicare ID - Type Unspecified