Provider Demographics
NPI:1831104371
Name:GEISE, LOURDES HEUMANN (MD)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:HEUMANN
Last Name:GEISE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LOURDES
Other - Middle Name:ELIZABETH
Other - Last Name:HEUMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5550 S EAST ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1979
Mailing Address - Country:US
Mailing Address - Phone:317-534-4660
Mailing Address - Fax:317-782-4301
Practice Address - Street 1:5550 S EAST ST
Practice Address - Street 2:SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1979
Practice Address - Country:US
Practice Address - Phone:317-534-4660
Practice Address - Fax:317-782-4301
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042120A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200898990Medicaid