Healthcare Provider Details

I. General information

NPI: 1104819861
Provider Name (Legal Business Name): GREGORY M GEORGIADIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 11/03/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 HUGHES DR SUITE 310
TOLEDO OH
43606-3845
US

IV. Provider business mailing address

2121 HUGHES DR SUITE 310
TOLEDO OH
43606-3845
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-3858
  • Fax: 419-482-8701
Mailing address:
  • Phone: 419-291-3858
  • Fax: 419-482-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number35058405
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35058405
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: