Provider Demographics
NPI:1558374017
Name:GIESE, TODD STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:STANLEY
Last Name:GIESE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 MCHENRY AVE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-7444
Mailing Address - Country:US
Mailing Address - Phone:815-459-2200
Mailing Address - Fax:815-459-0556
Practice Address - Street 1:781 MCHENRY AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-7444
Practice Address - Country:US
Practice Address - Phone:815-459-2200
Practice Address - Fax:815-459-0556
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics