| NPI | 1104600048 |
|---|---|
| Doing Business As | GREEN ST FAMILY MEDICINE |
| Entity Type | Organization |
| Authorized Contact | HEATHER RUTHERFORD Credentialing COO Rdinator 317-837-5566 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2023-08-22 |