Provider Demographics
NPI:1699431411
Name:KRISTIE GREENE, MD LLC
Entity type:Organization
Organization Name:KRISTIE GREENE, MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-799-5753
Mailing Address - Street 1:1617 S TUTTLE AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3132
Mailing Address - Country:US
Mailing Address - Phone:941-799-5753
Mailing Address - Fax:888-814-0877
Practice Address - Street 1:1617 S TUTTLE AVE STE 1A
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3132
Practice Address - Country:US
Practice Address - Phone:941-799-5753
Practice Address - Fax:888-814-0877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-16
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic SurgeryGroup - Single Specialty