MEDICARE: REITZ NEUROLOGY PLLC

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	174400000X	Specialist	13807	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	130005602	OTHER	OK	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1891082152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REITZ NEUROLOGY PLLC

Provider Business Mailing Address
First Line	:	1204 W WILLOW RD
Second Line	:	SUITE C
City	:	ENID
State	:	OK
Zip	:	73703-2531
Country	:	US
Telephone Number	:	580-237-0549
Fax Number	:	580-237-7851

Provider Business Practice Location Address
First Line	:	1204 W WILLOW RD
Second Line	:	SUITE C
City	:	ENID
State	:	OK
Zip	:	73703-2531
Country	:	US
Telephone Number	:	580-237-0549
Fax Number	:	580-237-7851

Authorized Official
Title or Position	:	MEMBER
Name	:	ROLFE DEAN REITZ
Credential	:	M.D.
Telephone Number	:	580-237-0549

Provider Enumeration Date	:	07/06/2011
Last Update Date	:	07/06/2011

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Directions to “REITZ NEUROLOGY PLLC ” Practice Location

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