Provider Demographics
NPI:1841239456
Name:GIESECKE, THOMAS F (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:F
Last Name:GIESECKE
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 1:4301 HOYT AVE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2316
Mailing Address - Country:US
Mailing Address - Phone:425-317-8025
Mailing Address - Fax:
Practice Address - Street 1:4301 HOYT AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2316
Practice Address - Country:US
Practice Address - Phone:425-317-8025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023088207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0176378OtherLABOR AND INDUSTRY
WAP00187171OtherRAILROAD MEDICARE
WAMD00023088OtherSTATE LICENSE NUMBER
WA1005438Medicaid
WAP00187171OtherRAILROAD MEDICARE
WAA04550Medicare UPIN