Provider Demographics
NPI:1962499160
Name:F GARY GIESEKE MD PA
Entity Type:Organization
Organization Name:F GARY GIESEKE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:F GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIESEKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-771-4251
Mailing Address - Street 1:1821 NE 25TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7744
Mailing Address - Country:US
Mailing Address - Phone:954-771-4251
Mailing Address - Fax:954-491-4892
Practice Address - Street 1:1821 NE 25TH ST STE 101
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7744
Practice Address - Country:US
Practice Address - Phone:954-771-4251
Practice Address - Fax:954-491-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00344Medicare ID - Type Unspecified