Provider Demographics
NPI:1831124411
Name:GIESEKE, LISA K (DO)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:GIESEKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 S POTOMAC ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4536
Mailing Address - Country:US
Mailing Address - Phone:303-531-4910
Mailing Address - Fax:303-309-3733
Practice Address - Street 1:1411 S POTOMAC ST
Practice Address - Street 2:SUITE 300
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4536
Practice Address - Country:US
Practice Address - Phone:303-531-4910
Practice Address - Fax:303-309-3733
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO35455207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01354554Medicaid
CO01354554Medicaid