Provider Demographics
NPI:1841272499
Name:GREENE, KATHIE T (MD)
Entity type:Individual
Prefix:
First Name:KATHIE
Middle Name:T
Last Name:GREENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 LAKE SUMTER LNDG
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2699
Mailing Address - Country:US
Mailing Address - Phone:352-674-8905
Mailing Address - Fax:352-674-8901
Practice Address - Street 1:779 KRISTINE WAY
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163
Practice Address - Country:US
Practice Address - Phone:844-884-9355
Practice Address - Fax:352-674-6030
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME152634207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0860206Medicaid
OH1821035940OtherMEDICARE / MEDICAID GROUP NPI #
OH1841239274OtherPPG TYPE 2 GROUP NPI #
OH3600271OtherMEDICARE GROUP PTAN #
OH0290886OtherMEDICAID GROUP #
OH0860206Medicaid