Provider Demographics
NPI:1629000732
Name:GERI CARE LTD
Entity Type:Organization
Organization Name:GERI CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:K
Authorized Official - Last Name:KATSOYANNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-299-7888
Mailing Address - Street 1:1600 W DEMPSTER ST
Mailing Address - Street 2:STE 120
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1171
Mailing Address - Country:US
Mailing Address - Phone:847-299-7888
Mailing Address - Fax:847-299-7844
Practice Address - Street 1:1600 W DEMPSTER ST
Practice Address - Street 2:STE 120
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1171
Practice Address - Country:US
Practice Address - Phone:847-299-7888
Practice Address - Fax:847-299-7844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036096130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC41777Medicare UPIN