Provider Demographics
NPI:1407187636
Name:WISDOM HEALTH PC
Entity Type:Organization
Organization Name:WISDOM HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIESEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-938-1110
Mailing Address - Street 1:2950 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-2720
Mailing Address - Country:US
Mailing Address - Phone:303-938-1110
Mailing Address - Fax:
Practice Address - Street 1:350 PONCA PL
Practice Address - Street 2:SUITE 250
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-3828
Practice Address - Country:US
Practice Address - Phone:303-938-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO40821207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H08025Medicare UPIN
COC517398Medicare PIN