Healthcare Provider Details

I. General information

NPI: 1437146081
Provider Name (Legal Business Name): JOHN P. GEISLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 05/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 E DUPONT RD STE 236
FORT WAYNE IN
46825-1603
US

IV. Provider business mailing address

3355 GLENDALE AVE THIRD FLOOR
TOLEDO OH
43614-2426
US

V. Phone/Fax

Practice location:
  • Phone: 260-458-3760
  • Fax: 260-458-3761
Mailing address:
  • Phone: 419-383-7100
  • Fax: 419-383-2000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number01044147A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: