Healthcare Provider Details

I. General information

NPI: 1568542140
Provider Name (Legal Business Name): REENA A GEORGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 N MAIN ST STE 201
THIENSVILLE WI
53092-1606
US

IV. Provider business mailing address

PO BOX 210560
MILWAUKEE WI
53221-8010
US

V. Phone/Fax

Practice location:
  • Phone: 262-242-3369
  • Fax: 833-599-2486
Mailing address:
  • Phone: 414-875-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number40020
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number40020
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number40020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: