Green, Jacinta

Green, Jacinta is an individual health care provider with primary practice located at 4425 W 63Rd St Ste 204 , Chicago IL 60629-5565. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Cardiovascular Disease. Allopathic & Osteopathic Physicians / Cardiovascular Disease is her primary health care specialty. Green, Jacinta can be contacted via phone (888) 876-7012.

Contact Information

Primary practice address
4425 W 63Rd St Ste 204 Chicago IL 60629-5565
Phone: (888) 876-7012
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 125:056090 Illinois
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 036.139092 Illinois

Profile Details

NPI number 1982830238
LBN Legal business name Green, Jacinta
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 1st, 2009
Last updated May 20th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982830238 NPPES
Illinois MEDICAID 036139092

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