Provider Demographics
NPI:1194729699
Name:GEISSLER, JAMES A (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:GEISSLER
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 1:4444 KALAMAZOO AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-4600
Mailing Address - Country:US
Mailing Address - Phone:616-391-5600
Mailing Address - Fax:616-391-5685
Practice Address - Street 1:4444 KALAMAZOO AVE SE
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:MI
Practice Address - Zip Code:49508-4600
Practice Address - Country:US
Practice Address - Phone:616-391-5600
Practice Address - Fax:616-391-5685
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4199802Medicaid
MI4199802Medicaid
MIOD14835016Medicare ID - Type Unspecified