Provider Demographics
NPI:1538141023
Name:REISTER, JAMI (MD)
Entity type:Individual
Prefix:
First Name:JAMI
Middle Name:
Last Name:REISTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-1498
Mailing Address - Country:US
Mailing Address - Phone:507-646-1000
Mailing Address - Fax:
Practice Address - Street 1:2000 NORTH AVE
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-1498
Practice Address - Country:US
Practice Address - Phone:507-646-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5611490Medicaid
H93431Medicare UPIN
41437Medicare ID - Type Unspecified