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Contact Information

PETER GREEN, LADC
3400 E LAKE ST
MINNEAPOLIS, MN55406-2150
 Phone: 651-274-0986
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Addiction (Substance Use Disorder)

101YA0400X
 

Other Service Providers

175T00000X
Indicates primary specialty

NPI Profile & details for PETER GREEN · (Male)

NPI # 1992347694
Status Active
Credentials LADC
Entity Individual
Enumeration date 10/14/2019
Last updated 12/17/2025 - About 6 months ago
Sole proprietor 1 No
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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