Basic Information
| Provider Information | |||||||||
| NPI: | 1336184936 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CIEUTAT | ||||||||
| FirstName: | EVE | ||||||||
| MiddleName: | GRACE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2996 KATE BOND ROAD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | BARTLETT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381334062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013002970 | ||||||||
| FaxNumber: | 9013848988 | ||||||||
| Practice Location | |||||||||
| Address1: | 2996 KATE BOND ROAD | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | BARTLETT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381334062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013002970 | ||||||||
| FaxNumber: | 9013848988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 02/12/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | 48213 | TN | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 051520825 | 05 | AL | MEDICAID |