Provider Demographics
NPI:1093082869
Name:GEIS, MICHAEL WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILLIAM
Last Name:GEIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 STRAWBERRY HILL CT
Mailing Address - Street 2:8 C
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2548
Mailing Address - Country:US
Mailing Address - Phone:207-232-9437
Mailing Address - Fax:
Practice Address - Street 1:1435 BEDFORD ST
Practice Address - Street 2:SUITE 1 R
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-5246
Practice Address - Country:US
Practice Address - Phone:203-832-6992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-22
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275366204D00000X
CT052918204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM