Provider Demographics
NPI:1861547952
Name:GREENSPON, JAMES RICHARD (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:RICHARD
Last Name:GREENSPON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18225 TORRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2729
Mailing Address - Country:US
Mailing Address - Phone:708-474-1061
Mailing Address - Fax:708-474-1063
Practice Address - Street 1:18225 TORRENCE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-2729
Practice Address - Country:US
Practice Address - Phone:708-474-1061
Practice Address - Fax:708-474-1063
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE88805Medicare UPIN