Basic Information
Provider Information
NPI: 1366631509
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REINTJES
FirstName: KURT
MiddleName: L
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5080 SPECTRUM DR
Address2: SUITE 1200 WEST TOWER
City: ADDISON
State: TX
PostalCode: 750014648
CountryCode: US
TelephoneNumber: 8002323550
FaxNumber:  
Practice Location
Address1: 2455 N 124TH ST
Address2:  
City: BROOKFIELD
State: WI
PostalCode: 530054630
CountryCode: US
TelephoneNumber: 2627829326
FaxNumber: 2627829353
Other Information
ProviderEnumerationDate: 10/23/2007
LastUpdateDate: 10/23/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208100000X50846-020WIY Allopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 

No ID Information.


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