Healthcare Provider Details

I. General information

NPI: 1568465540
Provider Name (Legal Business Name): JEFFREY A GIESE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W TIPTON ST
SEYMOUR IN
47274-2363
US

IV. Provider business mailing address

PO BOX 4777
BLOOMINGTON IN
47402-4777
US

V. Phone/Fax

Practice location:
  • Phone: 812-522-0136
  • Fax:
Mailing address:
  • Phone: 812-336-1690
  • Fax: 812-349-1311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number200000801
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: