Basic Information
Provider Information
NPI: 1598776932
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GREENBERG
FirstName: STEVEN
MiddleName: BRETT
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
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OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
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Mailing Information
Address1: 2650 RIDGE AVE
Address2: DEPARTMENT OF ANESTHESIA
City: EVANSTON
State: IL
PostalCode: 602011718
CountryCode: US
TelephoneNumber: 8475702760
FaxNumber: 8475702921
Practice Location
Address1: 2650 RIDGE AVE
Address2: DEPARTMENT OF ANESTHESIA
City: EVANSTON
State: IL
PostalCode: 602011718
CountryCode: US
TelephoneNumber: 8475702760
FaxNumber: 8475702921
Other Information
ProviderEnumerationDate: 08/10/2006
LastUpdateDate: 10/22/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207LC0200X036115223ILN Allopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
207L00000X036115223ILY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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