Provider Demographics
NPI:1437653367
Name:GEORGIS, MATTHEW THEODORE (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:THEODORE
Last Name:GEORGIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:921 OAK PARK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3400
Mailing Address - Country:US
Mailing Address - Phone:805-546-0411
Mailing Address - Fax:805-473-4891
Practice Address - Street 1:3990 JOHN R ST
Practice Address - Street 2:HARPER PROFESSIONAL BUILDING, SUITE 615
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-4195
Practice Address - Fax:313-993-8669
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA2013802086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery