T G Green DO SC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

16986 Issued in WI

Legal business name

T G GREEN DO SC

Practice address

13760 W Capitol Dr
Brookfield, WI 53005-2407

Phone

(262) 781-1530

Fax

(262) 781-7941

NPI assigned

Dec 1, 2010

Last updated

Dec 1, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Theodore G Green, D.O.

Title

Physician

Phone

(262) 781-1530

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1291161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291161600000",
    "number": "1619279346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13760 W CAPITOL DR",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530052407",
            "telephone_number": "262-781-1530",
            "fax_number": "262-781-7941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13760 W CAPITOL DR",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530052407",
            "telephone_number": "262-781-1530",
            "fax_number": "262-781-7941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "T G GREEN DO SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-01",
        "last_updated": "2010-12-01",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "262-781-1530",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "16986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30039500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jamie Sylvester, APNP
• Nicole Szaniawski, RDN, CD
• Michael P. Szatalowicz, D.C.
• Sue A Szymanski, MT MASSAGE THERAPIST
• James Richard Szymczak, D.D.S.
• Michael Anthony Tabor, MSPT
• Thomas A Taft, MD
• Sarah Tajnai
• Thomas T Tang, D.D.S.
• Michael Charles Tankovich, OD

• Family Medicine Physician in Brookfield, WI
• Providers in Brookfield, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.