Healthcare Provider Details

I. General information

NPI: 1154469120
Provider Name (Legal Business Name): HILDEGARDE GEISSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 N ANDREWS AVE SUITE 530
FORT LAUDERDALE FL
33309-2114
US

IV. Provider business mailing address

6400 N ANDREWS AVE SUITE 530
FORT LAUDERDALE FL
33309-2114
US

V. Phone/Fax

Practice location:
  • Phone: 844-636-3876
  • Fax: 561-429-3630
Mailing address:
  • Phone: 954-530-4344
  • Fax: 561-429-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License NumberME96190
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME96190
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberME96190
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License NumberME96190
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: