Healthcare Provider Details

I. General information

NPI: 1972739647
Provider Name (Legal Business Name): KYLE ELIZABETH GEISSLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 05/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 LAKE ST
OAK PARK IL
60302-2606
US

IV. Provider business mailing address

14 LAKE ST
OAK PARK IL
60302-2606
US

V. Phone/Fax

Practice location:
  • Phone: 708-383-0113
  • Fax: 708-383-9911
Mailing address:
  • Phone: 708-383-0113
  • Fax: 708-383-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125055781
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: