Provider Demographics
NPI:1154469120
Name:GEISSE, HILDEGARDE (MD)
Entity Type:Individual
Prefix:
First Name:HILDEGARDE
Middle Name:
Last Name:GEISSE
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 1:6400 N ANDREWS AVE
Mailing Address - Street 2:SUITE 530
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-2114
Mailing Address - Country:US
Mailing Address - Phone:954-530-4344
Mailing Address - Fax:561-429-3630
Practice Address - Street 1:6400 N ANDREWS AVE
Practice Address - Street 2:SUITE 530
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2114
Practice Address - Country:US
Practice Address - Phone:844-636-3876
Practice Address - Fax:561-429-3630
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME961902084N0600X, 2084N0400X, 204D00000X, 2084N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBH804ZMedicare PIN
FLH0685AMedicare PIN