Provider Demographics
NPI:1972127165
Name:GREENE-ROPER, JACQUELINE MARCELLA (MD)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:MARCELLA
Last Name:GREENE-ROPER
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 1:8321 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1669
Mailing Address - Country:US
Mailing Address - Phone:708-681-2298
Mailing Address - Fax:
Practice Address - Street 1:8321 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1669
Practice Address - Country:US
Practice Address - Phone:708-681-2298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.163419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine