Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 5101016991 | MI |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 55576021 | WI |
NPI | 1528283926 |
---|---|
Provider Name | Dr. Charles Joseph Green |
First Address | Sheboygan, WI 53083-4212 |
Second Address | Sheboygan, WI 53081-3129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 22/11/2021 |