Healthcare Provider Details

I. General information

NPI: 1992883482
Provider Name (Legal Business Name): CHRISTINE M REARDON DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4448 W LOOMIS RD STE. 204
GREENFIELD WI
53220-4851
US

IV. Provider business mailing address

100-15TH AVE. STE 180
SOUTH MILWAUKEE WI
53172-1160
US

V. Phone/Fax

Practice location:
  • Phone: 414-281-5150
  • Fax: 414-281-5767
Mailing address:
  • Phone: 414-768-5430
  • Fax: 414-762-4225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number756-25
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number756
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: