Provider Demographics
NPI:1285829994
Name:LIVIERATOS, SPEROS G (MD)
Entity Type:Individual
Prefix:
First Name:SPEROS
Middle Name:G
Last Name:LIVIERATOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HEALTH PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-4692
Mailing Address - Country:US
Mailing Address - Phone:615-372-5068
Mailing Address - Fax:
Practice Address - Street 1:908 BYPASS RD
Practice Address - Street 2:PIKEVILLE MEDICAL CENTER
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-2602
Practice Address - Country:US
Practice Address - Phone:606-218-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-06
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY45686207RC0200X, 207RP1001X
GA64669207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100269940Medicaid
KYK101400Medicare PIN