Healthcare Provider Details

I. General information

NPI: 1114920964
Provider Name (Legal Business Name): STEVEN PATRICK GEIERMANN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5218 N WINTHROP AVE # 3N
CHICAGO IL
60640-2306
US

IV. Provider business mailing address

5218 N WINTHROP AVE # 3N
CHICAGO IL
60640-2306
US

V. Phone/Fax

Practice location:
  • Phone: 773-271-5871
  • Fax: 312-886-3770
Mailing address:
  • Phone: 773-271-5871
  • Fax: 312-886-3770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2901013456
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: