Provider Demographics
NPI:1841666567
Name:GREEN, JAMES T II
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:GREEN
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 W CAPITOL DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1948
Mailing Address - Country:US
Mailing Address - Phone:414-469-4942
Mailing Address - Fax:
Practice Address - Street 1:8201 W CAPITOL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-1948
Practice Address - Country:US
Practice Address - Phone:414-469-4942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator