Provider Demographics
NPI:1245454222
Name:V GREENE MD PC
Entity type:Organization
Organization Name:V GREENE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VYBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-791-2812
Mailing Address - Street 1:80 BURR RIDGE PKWY
Mailing Address - Street 2:PMB 144
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-0832
Mailing Address - Country:US
Mailing Address - Phone:708-788-2038
Mailing Address - Fax:
Practice Address - Street 1:1322 E 47TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60653-4508
Practice Address - Country:US
Practice Address - Phone:773-924-1978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089662207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089662Medicaid
IL1942347141OtherNPI
IL208965Medicare ID - Type Unspecified
IL1942347141OtherNPI