Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5151015274 | MI |
NPI | 1245808237 |
---|---|
Provider Name | Benjamin Joseph Kiyoshi Greene |
First Address | Lansing, MI 48912 |
Second Address | Lansing, MI 48912-1896 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2021 |
Last Update Date | 15/06/2021 |