Healthcare Provider Details

I. General information

NPI: 1932146842
Provider Name (Legal Business Name): GENNADY GEKHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 05/26/2022
Certification Date: 05/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 LAKEWOOD RANCH BLVD STE 300
LAKEWOOD RANCH FL
34202-5046
US

IV. Provider business mailing address

8000 SR 64 E
BRADENTON FL
34212
US

V. Phone/Fax

Practice location:
  • Phone: 974-792-1404
  • Fax: 941-795-1717
Mailing address:
  • Phone: 941-792-1404
  • Fax: 941-795-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number053530
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME95933
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: