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DR. KALLA ALEXIS GERVASIO MD NPI 1619409364


NPI Information

NPI: 1619409364
Provider Name: DR. KALLA ALEXIS GERVASIO, MD
Classification: Ophthalmology - 207WX0200X
Entity Type: Individual

Specialization: Ophthalmic Plastic and Reconstructive Surgery

PECOS Registration: Yes

Address:
4901 FOREST PARK AVE
DEPT OPHTHALMOLOGY, 6TH FL
SAINT LOUIS, MO
ZIP 63108
Phone: (314) 362-3937
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DR. Kalla Alexis Gervasio, MD is an ophthalmic plastic and reconstructive surgery ophthalmology in Saint Louis, MO with 7 years of experience. The provider is a physician who specializes in oculofacial plastic and reconstructive surgery. This subspecialty combines orbital and periocular surgery with facial plastic surgery, and includes aesthetic and reconstructive surgery of the face, orbit, eyelid, and lacrimal system. Practitioners evaluate, diagnose and treat conditions involving the eyelids, brows, midface, orbits, lacrimal systems and surrounding and supporting structures of the face and neck. DR. Kalla Alexis Gervasio, MD NPI is 1619409364. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
Graduation Year:2017

The provider's business location address is:

4901 FOREST PARK AVE
DEPT OPHTHALMOLOGY, 6TH FL
SAINT LOUIS, MO
ZIP 63108-495
Phone: (314) 362-3937
Fax: (314) 362-3725

The NPI 1619409364 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/31/2017 and was last updated on 4/25/2024.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207WX0200XOphthalmologyOphthalmic Plastic and Reconstructive Surgery2022016365MISSOURIYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1200109577MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.