MEDICARE: GEORGE T REIZNER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	24291	WI

General Provider Information

NPI Number	:	1023077252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE T REIZNER MD

Provider Business Mailing Address
First Line	:	3218 SANDWOOD WAY
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53713-3474
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3218 SANDWOOD WAY
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53713-3474
Country	:	US
Telephone Number	:	--
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	08/20/2021

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