Healthcare Provider Details

I. General information

NPI: 1740287101
Provider Name (Legal Business Name): MARK S GEISSLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 W FAIR AVENUE SUITE 230
MARQUETTE MI
49855-2675
US

IV. Provider business mailing address

1414 W FAIR AVENUE SUITE 230
MARQUETTE MI
49855-2675
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-3853
  • Fax: 906-228-4065
Mailing address:
  • Phone: 906-225-3853
  • Fax: 906-228-4065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMG061171
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: