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General NPI Number Information
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NPI Number | 1659854446
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Entity Type | Individual
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Provider Name | ADAM REISERT PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/08/2018
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 1100 REID PKWY
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City | RICHMOND
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State | IN
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Zip | 47374-1157
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Country | US
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Telephone | 765-338-6453
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 W 3RD ST
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City | CONNERSVILLE
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State | IN
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Zip | 47331-1025
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Country | US
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Telephone | 765-338-6453
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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