Basic Information
Provider Information | |||||||||
NPI: | 1801258397 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | REISINGER-KINDLE | ||||||||
FirstName: | KEITH | ||||||||
MiddleName: | MICHAEL | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO, MPH, MS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | REISINGER | ||||||||
OtherFirstName: | KEITH | ||||||||
OtherMiddleName: | MICHAEL | ||||||||
OtherNamePrefix: | MR. | ||||||||
OtherNameSuffix: | II | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 725 UNIVERSITY BLVD | ||||||||
Address2: |   | ||||||||
City: | BEAVERCREEK | ||||||||
State: | OH | ||||||||
PostalCode: | 453242640 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9372457200 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 725 UNIVERSITY BLVD | ||||||||
Address2: |   | ||||||||
City: | BEAVERCREEK | ||||||||
State: | OH | ||||||||
PostalCode: | 453242640 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9372457200 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/23/2016 | ||||||||
LastUpdateDate: | 03/27/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/27/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 34.014333 | OH | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
No ID Information.