Provider Demographics
NPI:1669452959
Name:GIESTING, JEROME R (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:R
Last Name:GIESTING
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:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:CONNERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47331-0779
Mailing Address - Country:US
Mailing Address - Phone:765-825-8686
Mailing Address - Fax:
Practice Address - Street 1:1475 E STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-8292
Practice Address - Country:US
Practice Address - Phone:765-825-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023882A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND69500Medicare UPIN