Provider Demographics
NPI:1699737361
Name:REISING, MICHAEL PATRICK (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PATRICK
Last Name:REISING
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3424 TRIO LN
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2071
Mailing Address - Country:US
Mailing Address - Phone:916-747-4825
Mailing Address - Fax:
Practice Address - Street 1:3424 TRIO LN
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2071
Practice Address - Country:US
Practice Address - Phone:916-747-4825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2015-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103129363AS0400X
CAPA-16318363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292180400Medicaid
FLP00242516OtherRAILROAD MEDICARE
FLU4904BMedicare PIN
FLU4904AMedicare PIN
FL292180400Medicaid
FLP00242516OtherRAILROAD MEDICARE