Provider Demographics
NPI:1669884441
Name:KATSEVMAN, GENNADIY ALEKSANDROVICH (MD)
Entity type:Individual
Prefix:DR
First Name:GENNADIY
Middle Name:ALEKSANDROVICH
Last Name:KATSEVMAN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3451 PINE RIDGE RD BLDG 601
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-3922
Mailing Address - Country:US
Mailing Address - Phone:239-449-3072
Mailing Address - Fax:877-334-1886
Practice Address - Street 1:6101 PINE RIDGE RD STE 101
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34119-3900
Practice Address - Country:US
Practice Address - Phone:239-649-1662
Practice Address - Fax:877-334-1886
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV27090207T00000X
AZ62548207T00000X
FLME157518207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ092339Medicaid