Provider Demographics
NPI:1982690269
Name:GREENE, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:GREENE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-4141
Mailing Address - Country:US
Mailing Address - Phone:772-581-5848
Mailing Address - Fax:772-581-5849
Practice Address - Street 1:816 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-4141
Practice Address - Country:US
Practice Address - Phone:772-581-5848
Practice Address - Fax:772-581-5849
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME65689208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373207000Medicaid
FL254440700Medicaid
FL593493501OtherGROUP TAX ID
FL21810OtherGROUP BCBS ID
FL68633OtherINDIVIDUAL BCBS ID
FL330004682OtherMEDICARE RAILROAD ID
FL8179974003OtherINDIVIDUAL CIGNA ID
FLC63948Medicare UPIN
FL330004682OtherMEDICARE RAILROAD ID
FLK0353Medicare PIN
FL254440700Medicaid
FL68633XMedicare PIN