Basic Information
Provider Information
NPI: 1871911768
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REIFF
FirstName: CHRISTOPHER
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8170 33RD AVE S # MS 21110Q
Address2:  
City: BLOOMINGTON
State: MN
PostalCode: 554254516
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 6500 EXCELSIOR BLVD
Address2:  
City: ST LOUIS PARK
State: MN
PostalCode: 554264702
CountryCode: US
TelephoneNumber: 9529933246
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/28/2014
LastUpdateDate: 03/12/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/12/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X62166MNY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


Home