Provider Demographics
NPI:1902957335
Name:KATHIET GREENE, MD, INC
Entity type:Organization
Organization Name:KATHIET GREENE, MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KATHIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-516-3776
Mailing Address - Street 1:30575 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:WICKLIFFE
Mailing Address - State:OH
Mailing Address - Zip Code:44092-1037
Mailing Address - Country:US
Mailing Address - Phone:440-516-3776
Mailing Address - Fax:440-516-3783
Practice Address - Street 1:30575 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WICKLIFFE
Practice Address - State:OH
Practice Address - Zip Code:44092-1037
Practice Address - Country:US
Practice Address - Phone:440-516-3776
Practice Address - Fax:440-516-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062093G273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0860206Medicaid
OH9332491Medicare ID - Type Unspecified
OH0860206Medicaid