Provider Demographics
NPI:1639341795
Name:KOCOUREK, GENEVIE LOREE (MD)
Entity Type:Individual
Prefix:
First Name:GENEVIE
Middle Name:LOREE
Last Name:KOCOUREK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GENEVIE
Other - Middle Name:LOREE
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25764 N 104TH WAY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-8191
Mailing Address - Country:US
Mailing Address - Phone:480-714-5692
Mailing Address - Fax:888-372-3577
Practice Address - Street 1:25764 N 104TH WAY
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-8191
Practice Address - Country:US
Practice Address - Phone:480-714-5692
Practice Address - Fax:888-372-3577
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-28
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI53754207Q00000X
AZ62177207Q00000X
COCDR.0000875207Q00000X
NV20336207Q00000X
UT11961125-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine