Healthcare Provider Details

I. General information

NPI: 1679404644
Provider Name (Legal Business Name): LANE GEISNESS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44405 WOODWARD AVE
PONTIAC MI
48341-5023
US

IV. Provider business mailing address

1711 PATRICIA LN
WAUKESHA WI
53188-2176
US

V. Phone/Fax

Practice location:
  • Phone: 248-858-3234
  • Fax:
Mailing address:
  • Phone: 262-744-3942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4351056813
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: