Provider Demographics
NPI:1154411874
Name:GEISEN, ALBERT LOUIS (MD)
Entity type:Individual
Prefix:
First Name:ALBERT
Middle Name:LOUIS
Last Name:GEISEN
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 1:651 E PRESCOTT RD
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-7408
Mailing Address - Country:US
Mailing Address - Phone:785-825-7251
Mailing Address - Fax:785-825-6887
Practice Address - Street 1:651 E PRESCOTT RD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-7408
Practice Address - Country:US
Practice Address - Phone:785-825-7251
Practice Address - Fax:785-825-6887
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10507207Q00000X
KS04-26383207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F62192Medicare UPIN