Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 21697 | WI |
NPI | 1306812094 |
---|---|
Provider Name | Christopher G Green |
First Address | Middleton, WI 53562-5531 |
Second Address | Cross Plains, WI 53528-9795 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 18/03/2019 |