Provider Demographics
NPI:1235687666
Name:GREEN SURGICAL, LLC.
Entity type:Organization
Organization Name:GREEN SURGICAL, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHBANDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-750-9630
Mailing Address - Street 1:PO BOX 10713
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46411
Mailing Address - Country:US
Mailing Address - Phone:219-750-9630
Mailing Address - Fax:
Practice Address - Street 1:8687 CONNECTICUT ST
Practice Address - Street 2:SUITE D
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6361
Practice Address - Country:US
Practice Address - Phone:219-750-9630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain