Basic Information
| Provider Information | |||||||||
| NPI: | 1154473759 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEORGEL | ||||||||
| FirstName: | AARON | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 766351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 4123 DUTCHMAN'S LANE | ||||||||
| Address2: | STE. 401 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402074733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023946341 | ||||||||
| FaxNumber: | 5023946340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 07/21/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA692 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AS0400X | PA692 | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 085460 | 01 | SIHO - CTS | OTHER | 2838725000 | 01 | PAD - CTS 560 | OTHER | 000000507776 | 01 | ANTHEM -CTS | OTHER | P00394137 | 01 | KY | RRMCR - CTS | OTHER | 50014981 | 01 | PASSPORT - CTS 560 | OTHER | 50030383 | 01 | KY | PASSPORT- NOTC | OTHER | 95001962 | 05 | KY | MEDICAID |