Ivan Green

NPI 1053615831 · on the registry since 2011 · sole proprietor

Practice

Address: 19551 E 10 Mile Rd
Roseville, MI 48066
Phone: (586) 775-6770
Organisation at this address: Convenient Rv Pc
Revive Physician Woundcare Specialists Pllc
Martin E. Guyer D.D.S. Professional Corporation
Inferred from a shared address, not stated in the registry.

Registry record

Primary taxonomy: 1223G0001X
1223G0001X
Licence states on file: MI
From the registry's licence fields, which are often incomplete.
Sex: Male
Record last updated: 2011-01-07

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Michigan