Provider Demographics
NPI:1093790966
Name:CIESEMIER, GEMMA A (DO)
Entity Type:Individual
Prefix:
First Name:GEMMA
Middle Name:A
Last Name:CIESEMIER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GEMMA
Other - Middle Name:A
Other - Last Name:ARBUES GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:610 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2477
Mailing Address - Country:US
Mailing Address - Phone:660-627-2740
Mailing Address - Fax:660-665-0448
Practice Address - Street 1:610 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2477
Practice Address - Country:US
Practice Address - Phone:660-627-2740
Practice Address - Fax:660-665-0448
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002021764207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO208974808Medicaid
MO208974808Medicaid