Provider Demographics
NPI:1649443722
Name:GREEN, ERIKA (MD)
Entity type:Individual
Prefix:DR
First Name:ERIKA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ERIKA
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3677 GOULD DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033
Mailing Address - Country:US
Mailing Address - Phone:317-703-4414
Mailing Address - Fax:844-732-1277
Practice Address - Street 1:3677 GOULD DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033
Practice Address - Country:US
Practice Address - Phone:317-703-4414
Practice Address - Fax:844-732-1277
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062929A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01069215OtherRR MEDICARE
IN201086540Medicaid
INM400073500Medicare PIN