Basic Information
| Provider Information | |||||||||
| NPI: | 1285637181 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREEN | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 48 S GREENLEAF ST | ||||||||
| Address2: | |||||||||
| City: | GURNEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600313300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476684016 | ||||||||
| FaxNumber: | 8476624174 | ||||||||
| Practice Location | |||||||||
| Address1: | 48 S GREENLEAF ST | ||||||||
| Address2: | |||||||||
| City: | GURNEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600313300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476684016 | ||||||||
| FaxNumber: | 8476624174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | IL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.