Provider Demographics
NPI:1770585267
Name:GREEN, DAMON C (MD)
Entity type:Individual
Prefix:
First Name:DAMON
Middle Name:C
Last Name:GREEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:812 N LOGAN AVE
Mailing Address - Street 2:ANESTHESIA
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-3752
Mailing Address - Country:US
Mailing Address - Phone:217-477-2940
Mailing Address - Fax:217-477-2936
Practice Address - Street 1:812 N LOGAN AVE
Practice Address - Street 2:ANESTHESIA
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3752
Practice Address - Country:US
Practice Address - Phone:217-477-2940
Practice Address - Fax:217-477-2936
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
IL036109916207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH99696Medicare UPIN