Healthcare Provider Details

I. General information

NPI: 1669656054
Provider Name (Legal Business Name): JESSE ROBERT GEIBE MD, MPH, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 SAMPSON ST. (FISHER HEALTH CLINIC/NHC-503) NAVAL HEALTH CLINIC GREAT LAKES
GREAT LAKES IL
60088-2942
US

IV. Provider business mailing address

1122 N. CLARK ST. #3302
CHICAGO IL
60610-7895
US

V. Phone/Fax

Practice location:
  • Phone: 847-688-6712
  • Fax: 847-688-3860
Mailing address:
  • Phone: 619-855-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number13333R
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number13333R
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number13333R
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number13333R
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13333R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: