Healthcare Provider Details

I. General information

NPI: 1932399243
Provider Name (Legal Business Name): AMALIA ANTIGONI GELLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMALIA A LOUPIS

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8601 W EMERALD ST STE 176 8601 W EMERALD ST STE 176
BOISE ID
83704-8297
US

IV. Provider business mailing address

8601 W EMERALD ST STE 176
BOISE ID
83704-8297
US

V. Phone/Fax

Practice location:
  • Phone: 208-793-7006
  • Fax:
Mailing address:
  • Phone: 208-793-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMC-1606
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberM5721
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number17114
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD61019445
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License NumberMD61019445
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: