Healthcare Provider Details

I. General information

NPI: 1558969196
Provider Name (Legal Business Name): MAYCEE GIELOW DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAYCEE BEKKEDAHL

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S EAGLE RD STE 1241
MERIDIAN ID
83642-6355
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-381-6930
  • Fax: 208-381-6931
Mailing address:
  • Phone: 208-381-8866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberPG205142
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4481207
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: