Healthcare Provider Details

I. General information

NPI: 1457312464
Provider Name (Legal Business Name): EVE M GERASIMOU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 15TH AVE S
GREAT FALLS MT
59405-5240
US

IV. Provider business mailing address

3000 15TH AVE S
GREAT FALLS MT
59405-5240
US

V. Phone/Fax

Practice location:
  • Phone: 406-454-2171
  • Fax: 406-771-3021
Mailing address:
  • Phone: 406-454-2171
  • Fax: 406-771-3021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8388
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number8388
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: