Provider Demographics
NPI:1336184936
Name:CIEUTAT, EVE GRACE (MD)
Entity Type:Individual
Prefix:
First Name:EVE
Middle Name:GRACE
Last Name:CIEUTAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2996 KATE BOND ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38133-4062
Mailing Address - Country:US
Mailing Address - Phone:901-300-2970
Mailing Address - Fax:901-384-8988
Practice Address - Street 1:2996 KATE BOND ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38133-4062
Practice Address - Country:US
Practice Address - Phone:901-300-2970
Practice Address - Fax:901-384-8988
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN48213208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051520825Medicaid
AL051520825Medicaid
F82996Medicare UPIN