Green, Kenneth O
Green, Kenneth O is an individual health care provider with primary practice located at 111 W Lincoln St , Belleville IL 62220-2019. He recently has only one registered license in Allopathic & Osteopathic Physicians / Ophthalmology, which is considered as his primary health care specialty. Green, Kenneth O can be contacted via phone (618) 234-1774.Contact Information
Primary practice address
111 W Lincoln St
Belleville IL 62220-2019
Phone: (618) 234-1774
Fax: (618) 234-7979
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Ophthalmology | 207W00000X | 036037266 | Illinois |
Profile Details
| NPI number | 1780680900 |
|---|---|
| LBN Legal business name | Green, Kenneth O |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 22nd, 2005 |
| Last updated | Apr 13th, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1780680900 | NPPES |
| Illinois | Other | 1376586685 | NPI GROUP |
| Illinois | MEDICAID | 036037266 | NPI GROUP |
| Illinois | Other | 211586 | NPI GROUP |
| Illinois | Other | CH6508 | NPI GROUP |
| Illinois | Other | P00216102 | NPI GROUP |
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