| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JEREMY GREEN | 1558012047 | 2022-01-16 |
Jeremy Green is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1558012047. Registration indicates Jeremy Green is a provider of services with a specialization in Other Service Providers, Driver (Driver, ) (Driver, Other Service Providers)
| Entity Type | Individual |
| Provider Name | Jeremy Green |
| Practice Office Address | 6808 S PERRY AVE CHICAGO, IL US |
| Practice Office Telephone | 7736173404 |
| Mailing Address | 6728 S PERRY AVE # 3N CHICAGO, IL 606213733 US |
| Business Telephone | 7736173404 |
| Code | Practice | License No State |
|---|---|---|
| 172A00000X PRIMARY | Other Service Providers Driver Driver Driver Other Service Providers | G65043289292
IL |