Individual
DEBORAH GEISMAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
10 N CUMBERLAND AVE, PARK RIDGE, IL 60068-3215
(847) 825-0300
(847) 825-1825
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036073437
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01623792
BLUE SHIELD BLUE CROSS
IL
05
—
036073437
—
IL
Enumeration date
10/28/2006
Last updated
06/27/2022
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