Provider Demographics
NPI:1043552391
Name:GIESE, KAREN M (RD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:GIESE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 FLAGSTAFF LN
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-3003
Mailing Address - Country:US
Mailing Address - Phone:847-882-6134
Mailing Address - Fax:847-882-6155
Practice Address - Street 1:645 FLAGSTAFF LN
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-3003
Practice Address - Country:US
Practice Address - Phone:847-882-6134
Practice Address - Fax:847-882-6155
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164-001616133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202782Medicare PIN