Healthcare Provider Details

I. General information

NPI: 1881960938
Provider Name (Legal Business Name): NATHANIEL CANTEY REISINGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 N NEW BALLAS RD STE 348
CREVE COEUR MO
63141-6846
US

IV. Provider business mailing address

PO BOX 78429
SAINT LOUIS MO
63178-8429
US

V. Phone/Fax

Practice location:
  • Phone: 314-548-0265
  • Fax: 314-548-6555
Mailing address:
  • Phone: 314-548-0265
  • Fax: 314-548-6555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number2024037985
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: