MEDICARE: SUSAN REISINGER, MD PROF. CORP.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295703346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN REISINGER, MD PROF. CORP.

Provider Business Mailing Address
First Line	:	PO BOX 745059
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-5059
Country	:	US
Telephone Number	:	702-508-9944
Fax Number	:	702-508-9944

Provider Business Practice Location Address
First Line	:	2851 N TENAYA WAY STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0453
Country	:	US
Telephone Number	:	702-243-3340
Fax Number	:	702-228-4724

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	MELISSA SCHROADER
Credential	:	CREDENTIALING
Telephone Number	:	602-932-8288

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	09/19/2024

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