Healthcare Provider Details

I. General information

NPI: 1265435853
Provider Name (Legal Business Name): CYNTHIA L GEOCARIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 GREENBRIER RD
GREEN BAY WI
54311-6519
US

IV. Provider business mailing address

100 THEDA CLARK MEDICAL PLZ STE 400
NEENAH WI
54956-2763
US

V. Phone/Fax

Practice location:
  • Phone: 920-288-8250
  • Fax: 920-288-8255
Mailing address:
  • Phone: 920-725-4527
  • Fax: 920-405-5388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number38001
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: