Provider Demographics
NPI:1649257510
Name:GREENLEE, WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:GREENLEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:MCGAW ENT., RM. 47
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-5221
Mailing Address - Fax:708-216-0899
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:MCGAW ENT., RM. 47
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-5221
Practice Address - Fax:708-216-0899
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL360728482085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36072848Medicaid
IL36072848Medicaid
IL200937Medicare ID - Type Unspecified
ILL90404Medicare ID - Type Unspecified