Green, Lisa J

Green, Lisa J is an individual health care provider with primary practice located at 31 W 155Th St , Harvey IL 60426. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / General Practice, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Green, Lisa J can be contacted via phone (708) 596-5177.

Contact Information

Primary practice address
31 W 155Th St Harvey IL 60426
Phone: (708) 596-5177
Fax: (708) 339-3583
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X 036086707 Illinois
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036086707 Illinois

Profile Details

NPI number 1114973062
LBN Legal business name Green, Lisa J
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date May 25th, 2006
Last updated Jul 18th, 2024 - about last year

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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114973062 NPPES
Illinois MEDICAID 036086707

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