Provider Demographics
NPI:1205006285
Name:MARK S. GEISSLER, M.D., P.C.
Entity Type:Organization
Organization Name:MARK S. GEISSLER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:KURIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-225-4510
Mailing Address - Street 1:1414 W FAIR AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2675
Mailing Address - Country:US
Mailing Address - Phone:906-225-3853
Mailing Address - Fax:906-228-4065
Practice Address - Street 1:1414 W FAIR AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2675
Practice Address - Country:US
Practice Address - Phone:906-225-3853
Practice Address - Fax:906-228-4065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010611712086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2405232590OtherBLUE CROSS BLUE SHIELD
MI2952097Medicaid
MI2952097Medicaid
2405232590OtherBLUE CROSS BLUE SHIELD