Healthcare Provider Details

I. General information

NPI: 1861673121
Provider Name (Legal Business Name): ROBERT B. GELLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2007
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MEMORIAL DR SUITE 1600
BERLIN WI
54923-1243
US

IV. Provider business mailing address

225 MEMORIAL DR SUITE 1600
BERLIN WI
54923-1243
US

V. Phone/Fax

Practice location:
  • Phone: 920-361-6360
  • Fax: 920-361-5324
Mailing address:
  • Phone: 920-361-6360
  • Fax: 920-361-5324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number43939
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: