Basic Information
| Provider Information | |||||||||
| NPI: | 1568542140 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GEORGE | ||||||||
| FirstName: | REENA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 210560 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532218010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4148750505 | ||||||||
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| Practice Location | |||||||||
| Address1: | 136 N MAIN ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | THIENSVILLE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530921606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622423369 | ||||||||
| FaxNumber: | 8335992486 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 40020 | WI | N | Allopathic & Osteopathic Physicians | Allergy & Immunology | 208000000X | 40020 | WI | N | Allopathic & Osteopathic Physicians | Pediatrics | 207RA0201X | 40020 | WI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology |
No ID Information.