Healthcare Provider Details

I. General information

NPI: 1912993403
Provider Name (Legal Business Name): FRED GEISLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 OGDEN AVE SUITE 335
AURORA IL
60504-5894
US

IV. Provider business mailing address

2020 OGDEN AVE SUITE 335
AURORA IL
60504-5894
US

V. Phone/Fax

Practice location:
  • Phone: 630-236-4303
  • Fax: 630-236-4317
Mailing address:
  • Phone: 630-236-4303
  • Fax: 630-236-4317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number036-085216
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: