MEDICARE: YEVGENIY I GEKKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172A00000X	Driver

General Provider Information

NPI Number	:	1851854566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YEVGENIY I GEKKER

Provider Business Mailing Address
First Line	:	10555 LAKE FOREST BLVD STE 3G
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-5206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10555 LAKE FOREST BLVD STE 3G
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70127-5206
Country	:	US
Telephone Number	:	504-324-2270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2019
Last Update Date	:	06/11/2019

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