Basic Information
| Provider Information | |||||||||
| NPI: | 1942347141 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREENE | ||||||||
| FirstName: | VYBERT | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15774 S LA GRANGE RD # 397 | ||||||||
| Address2: | |||||||||
| City: | ORLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604624766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7088731533 | ||||||||
| FaxNumber: | 7088731534 | ||||||||
| Practice Location | |||||||||
| Address1: | 2555 S KING DRIVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606162419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126744000 | ||||||||
| FaxNumber: | 3126744001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2007 | ||||||||
| LastUpdateDate: | 10/22/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 036-089662 | IL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 036089662 | 05 | IL | MEDICAID |