MEDICARE: DR. LOUIS JEREMY GELLER D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	5901001926	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4627620001	OTHER	MI	DMERC LICENSE NUMBER
2	4856352050	OTHER	MI	BLUE CROSS BLUE SHIELD OF MICHIGAN
3	101026	OTHER	MI	GREAT LAKES HEALTH PLAN
4	2430677	OTHER	MI	CIGNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134100720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS JEREMY GELLER D.P.M.

Provider Business Mailing Address
First Line	:	28460 SOUTHFIELD RD
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-2820
Country	:	US
Telephone Number	:	248-353-0096
Fax Number	:	248-809-6255

Provider Business Practice Location Address
First Line	:	28460 SOUTHFIELD RD
Second Line	:
City	:	LATHRUP VILLAGE
State	:	MI
Zip	:	48076-2820
Country	:	US
Telephone Number	:	248-353-0096
Fax Number	:	248-809-6255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	07/24/2019

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Directions to “ DR. LOUIS JEREMY GELLER D.P.M.” Practice Location

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