1003930611 NPI number — MRS. CARIANE M REESE P.A.

Table of content: MRS. CARIANE M REESE P.A. (NPI 1003930611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003930611 NPI number — MRS. CARIANE M REESE P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REESE
Provider First Name:
CARIANE
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003930611
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1860 PAYSPHERE CIR
Provider Second Line Business Mailing Address:
#310
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60674-0018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-420-2323
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
351 DELNOR DRIVE
Provider Second Line Business Practice Location Address:
#310
Provider Business Practice Location Address City Name:
GENEVA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-377-8708
Provider Business Practice Location Address Fax Number:
630-377-8774
Provider Enumeration Date:
03/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  085-002785 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 085-002785 . This is a "PHYSICIAN ASST LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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