Healthcare Provider Details

I. General information

NPI: 1407837354
Provider Name (Legal Business Name): WILLIAM DONALD GIESEKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 05/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5130 LINTON BLVD SUITE B2
DELRAY BEACH FL
33484-6596
US

IV. Provider business mailing address

5130 LINTON BLVD SUITE B2
DELRAY BEACH FL
33484-6596
US

V. Phone/Fax

Practice location:
  • Phone: 561-499-8025
  • Fax: 561-496-7949
Mailing address:
  • Phone: 561-499-8025
  • Fax: 561-496-7949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME15914
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: