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NPI Code Detail

MEDICARE: JILL M. REISMAN PA

MEDICARE: JILL M. REISMAN PA
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
1363A00000XPhysician Assistant10000734AIN
2363AM0700XMedical Physician Assistant10000734AIN

Other Identifiers

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

General Provider Information

NPI Number : 1881617538
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL M. REISMAN PA
Provider Business Mailing Address
First Line : PO BOX 781076
Second Line :
City : DETROIT
State : MI
Zip : 48278-1076
Country : US
Telephone Number : 317-528-4800
Fax Number : 317-865-1479
Provider Business Practice Location Address
First Line : 3900 ST FRANCIS WAY STE 200
Second Line :
City : LAFAYETTE
State : IN
Zip : 47905-4940
Country : US
Telephone Number : 765-502-4000
Fax Number : 765-402-4709
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2006
Last Update Date : 01/08/2026

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Directions to “ JILL M. REISMAN PA” Practice Location

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