MEDICARE: LOUIS J GELLER DPM PC

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	213E00000X	Podiatrist	0524	AZ
2	213E00000X	Podiatrist	5901001926	MI

Other Identifiers

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

General Provider Information

NPI Number	:	1982714903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUIS J GELLER DPM PC

Provider Business Mailing Address
First Line	:	25841 PEMBROKE RD
Second Line	:
City	:	HUNTINGTON WOODS
State	:	MI
Zip	:	48070-1621
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	:	OWNER
Name	:	LOUIS JEREMY GELLER
Credential	:
Telephone Number	:	248-353-0096

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/26/2019

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