Provider Demographics
NPI:1366778276
Name:GIESEN, URSULA ELISABETH (MD)
Entity type:Individual
Prefix:
First Name:URSULA
Middle Name:ELISABETH
Last Name:GIESEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5721 S MARYLAND AVE
Mailing Address - Street 2:MC 8016
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1425
Mailing Address - Country:US
Mailing Address - Phone:773-702-6435
Mailing Address - Fax:773-834-0748
Practice Address - Street 1:5721 S MARYLAND AVE
Practice Address - Street 2:MC 8016
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1425
Practice Address - Country:US
Practice Address - Phone:773-702-6435
Practice Address - Fax:773-834-0748
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125052804208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics