Provider Demographics
NPI:1881666782
Name:GEISS, PETER T (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:T
Last Name:GEISS
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N17 W24100 RIVERWOOD DR. SUITE 130
Mailing Address - Street 2:WAUKESHA HEALTH CARE INC.
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:N17 W24100 RIVERWOOD DR
Practice Address - Street 2:WAUKESHA HEALTH CARE INC, SUITE 130
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188
Practice Address - Country:US
Practice Address - Phone:262-928-4100
Practice Address - Fax:262-928-5835
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI24374207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30457600Medicaid
WI30457600Medicaid