Provider Demographics
NPI:1255340139
Name:GREENE, MARIANNE ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:ELIZABETH
Last Name:GREENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIANNE
Other - Middle Name:ELIZABETH
Other - Last Name:NUSSMEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1910 N BURLING ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5124
Mailing Address - Country:US
Mailing Address - Phone:773-505-9892
Mailing Address - Fax:
Practice Address - Street 1:1910 N BURLING ST
Practice Address - Street 2:UNIT A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-5124
Practice Address - Country:US
Practice Address - Phone:773-505-9892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-086197207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621061OtherBCBS IL
ILI494555Medicare UPIN
IL01621061OtherBCBS IL