Provider Demographics
NPI:1386752434
Name:REISWIG, JEFFREY S (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:REISWIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 W CENTRAL AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-9503
Mailing Address - Country:US
Mailing Address - Phone:316-722-6260
Mailing Address - Fax:316-721-8307
Practice Address - Street 1:8200 W CENTRAL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-9503
Practice Address - Country:US
Practice Address - Phone:316-722-6260
Practice Address - Fax:316-721-8307
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4-21934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1101OtherPREFERRED HEALTH SYSTEMS
KS080110398OtherTRAVELERS MEDICARE
KS051999OtherBLUE CROSS BLUE SHIELD
KS100135550BMedicaid
KS4103553OtherAETNA
KS051999Medicare ID - Type Unspecified
KS1101OtherPREFERRED HEALTH SYSTEMS