| Doctor Name: | DR. GISELLE WILDMAN |
| NPI Number: | 1538249909 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DO |
| License Number: | 0529805 |
| Business Practice Address: | 3700 W 83rd Street Suite 115 Prairie Village, KS - 66208 |
| Business Phone Number: | 9133411200 |
| Business Fax Number: | 9133418077 |
| Mailing Address: | 3700 W 83rd Street, Suite 115 PRAIRIE VILLAGE |
| State: | KS |
| Postal Code: | 66208 |
| Phone Number: | 9133411200 |
| Fax Number: | 9133418077 |
| NPI Enumeration Date: | 10/17/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0529805 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KS |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |