MEDICARE: MR. JAMES WILLIAM GIESELMANN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	R7C04	MO
2	208600000X	Surgery Physician	10278	TN

General Provider Information

NPI Number	:	1750370748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES WILLIAM GIESELMANN MD

Provider Business Mailing Address
First Line	:	2210 BARRON RD
Second Line	:	SUITE 122
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-1908
Country	:	US
Telephone Number	:	573-686-2446
Fax Number	:	573-686-2447

Provider Business Practice Location Address
First Line	:	2210 BARRON RD
Second Line	:	SUITE 122
City	:	POPLAR BLUFF
State	:	MO
Zip	:	63901-1908
Country	:	US
Telephone Number	:	573-686-2446
Fax Number	:	573-686-2447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/08/2007

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