Provider Demographics
NPI:1407837354
Name:GIESEKE, WILLIAM DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DONALD
Last Name:GIESEKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5130 LINTON BLVD
Mailing Address - Street 2:SUITE B2
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6596
Mailing Address - Country:US
Mailing Address - Phone:561-499-8025
Mailing Address - Fax:561-496-7949
Practice Address - Street 1:5130 LINTON BLVD
Practice Address - Street 2:SUITE B2
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6596
Practice Address - Country:US
Practice Address - Phone:561-499-8025
Practice Address - Fax:561-496-7949
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME15914208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71271ZMedicare PIN
FLD58014Medicare UPIN