Kirk Dennis Green, D.O.
Individual provider Active NPI Orthopaedic Surgery Physician · Keokuk, IA
NPI 1982607487 · NPPES record last updated Jun 24, 2010
Key facts
- NPI
- 1982607487
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- License
- 01737 (IA)
- Practice address
- 400 N 17TH St
Keokuk, IA 52632-3452 - Phone
- (319) 524-5734
- Fax
- (319) 524-5758
- NPI assigned
- May 27, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri-State Medical Group Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 01737 | IA | Yes |
Addresses
Primary practice location
400 N 17TH St
Keokuk, IA 52632-3452
Mailing address
400 N 17TH St
Keokuk, IA 52632-3452
Phone (319) 524-5734
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2308999 | Medicaid | IA | |
| 54388 | Other | BLUE CROSS BLUE SHIELD |
Other providers in Keokuk, IA
- Courtney Fox
- Kimberly Dawn Fox
- Kathrin Frankenhoff
- Gemini Travel & Shuttle
- Gerald H. Schleier, D.D.S., S.C.
- Ricky James Greenfield
- Lacey Nicole Greenwald
- Lori Griswold
- Thomas E Hakes
- Erin Harbison
All providers in Keokuk, IA · Orthopaedic Surgery Physician in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.