Individual
MARK GIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 435-7001
Mailing address
12503 GOLDEN HARVEST DR, FORT WAYNE, IN 46845-9031
(260) 341-1795
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02001683
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200085640
—
IN
Enumeration date
07/08/2006
Last updated
11/14/2012
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