Provider Demographics
NPI:1356542500
Name:GREEN, BRIDGET ANNE (MD,)
Entity type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:ANNE
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD,
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Mailing Address - Street 1:6150 NORTHLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341
Mailing Address - Country:US
Mailing Address - Phone:616-942-9343
Mailing Address - Fax:616-942-2538
Practice Address - Street 1:6150 NORTHLAND DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341
Practice Address - Country:US
Practice Address - Phone:616-942-9343
Practice Address - Fax:616-942-2538
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301083630207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2166108Medicaid
MI0N13100006Medicare PIN