Basic Information
| Provider Information | |||||||||
| NPI: | 1720033772 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REINEKE | ||||||||
| FirstName: | JAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 N MICHIGAN ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466011077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742321471 | ||||||||
| FaxNumber: | 5742398511 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 N MICHIGAN ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466011077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742321471 | ||||||||
| FaxNumber: | 5742398511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 01021559A | IN | X | Other Service Providers | Specialist | 207V00000X | 01021559A | IN | X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.