Provider Demographics
NPI:1427448729
Name:MAGNIFICAT FAMILY MEDICINE, LLC
Entity type:Organization
Organization Name:MAGNIFICAT FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:REISING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-306-5588
Mailing Address - Street 1:8240 NAAB RD STE 416
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-0012
Mailing Address - Country:US
Mailing Address - Phone:317-306-5588
Mailing Address - Fax:317-550-1544
Practice Address - Street 1:8240 NAAB RD STE 416
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-0012
Practice Address - Country:US
Practice Address - Phone:317-306-5588
Practice Address - Fax:317-550-1544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-26
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01074227A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty