Provider Demographics
NPI:1639535677
Name:DAVID GELLER, MD, PLLC
Entity Type:Organization
Organization Name:DAVID GELLER, MD, PLLC
Other - Org Name:DAVID GELLER, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-893-7151
Mailing Address - Street 1:3999 DUTCHMANS LN STE 1E
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4741
Mailing Address - Country:US
Mailing Address - Phone:502-893-7151
Mailing Address - Fax:502-893-7020
Practice Address - Street 1:3999 DUTCHMANS LN STE 1E
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4741
Practice Address - Country:US
Practice Address - Phone:502-893-7151
Practice Address - Fax:502-893-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36536208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH47464Medicare UPIN