Provider Demographics
NPI:1003997636
Name:GROPPE GIESSELMANN, PAIGE L (MD)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:L
Last Name:GROPPE GIESSELMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025
Mailing Address - Country:US
Mailing Address - Phone:402-753-2900
Mailing Address - Fax:402-753-2926
Practice Address - Street 1:750 E 29TH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025
Practice Address - Country:US
Practice Address - Phone:402-753-2900
Practice Address - Fax:402-753-2926
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19644208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47081505113Medicaid
NEG75313Medicare UPIN
NE271202Medicare ID - Type UnspecifiedINDIVIDUAL #