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General NPI Number Information
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NPI Number | 1578275335
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Entity Type | Organization
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Legal Business Name | EQUITY CLINIC S.C.
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Dates
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Enumeration Date | 12/22/2022
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Last Update Date | 02/19/2023
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Provider Practice Location Address
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Address Line | 2111 W PARK CT
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City | CHAMPAIGN
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State | IL
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Zip | 61821-2986
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Country | US
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Telephone | 269-929-1064
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Fax |
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Provider Business Mailing Address
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Address Line | 2111 W PARK CT
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City | CHAMPAIGN
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State | IL
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Zip | 61821-2986
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Country | US
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Telephone | 224-350-2973
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/OWNER
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Name | DR. KEITH REISINGER-KINDLE
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Credential | DO, MPH, MS
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Telephone | 269-929-1064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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