Healthcare Provider Details

I. General information

NPI: 1588871024
Provider Name (Legal Business Name): EVE M GERASIMOU,MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 9TH ST S STE 302
GREAT FALLS MT
59405-4509
US

IV. Provider business mailing address

1417 9TH ST S STE 302
GREAT FALLS MT
59405-4509
US

V. Phone/Fax

Practice location:
  • Phone: 406-771-7700
  • Fax: 406-771-7720
Mailing address:
  • Phone: 406-771-7700
  • Fax: 406-771-7720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number8388
License Number StateMT

VIII. Authorized Official

Name: DR. EVE M GERASIMOU
Title or Position: OWNER
Credential: MD
Phone: 406-771-7700