Provider Demographics
NPI:1538249909
Name:WILDMAN, GISELLE (DO)
Entity type:Individual
Prefix:DR
First Name:GISELLE
Middle Name:
Last Name:WILDMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 W 83RD STREET
Mailing Address - Street 2:SUITE 115
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208
Mailing Address - Country:US
Mailing Address - Phone:913-341-1200
Mailing Address - Fax:913-341-8077
Practice Address - Street 1:3700 W 83RD STREET
Practice Address - Street 2:SUITE 115
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208
Practice Address - Country:US
Practice Address - Phone:913-341-1200
Practice Address - Fax:913-341-8077
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0529805208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice