MEDICARE: REICHERT & KELSEY PROSTHETICS ORTHOTICS, LLC

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	335E00000X	Prosthetic/Orthotic Supplier

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	:	1629367339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REICHERT & KELSEY PROSTHETICS ORTHOTICS, LLC

Provider Business Mailing Address
First Line	:	5027 GREEN BAY RD
Second Line	:	SUITE 124
City	:	KENOSHA
State	:	WI
Zip	:	53144-1771
Country	:	US
Telephone Number	:	262-654-4300
Fax Number	:	262-654-4305

Provider Business Practice Location Address
First Line	:	6790 W LAYTON AVE
Second Line	:
City	:	GREENFIELD
State	:	WI
Zip	:	53220-4571
Country	:	US
Telephone Number	:	414-282-3100
Fax Number	:	414-282-3101

Authorized Official
Title or Position	:	OWNER
Name	:	MR. BRIAN S KELSEY
Credential	:	CPO, LPO
Telephone Number	:	414-282-3100

Provider Enumeration Date	:	04/04/2011
Last Update Date	:	04/04/2011

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