MEDICARE: KAREN S. REISIG M.D.

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	207VG0400X	Gynecology Physician	1-3684	OK

General Provider Information

NPI Number	:	1982673984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN S. REISIG M.D.

Provider Business Mailing Address
First Line	:	13313 N MERIDIAN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8316
Country	:	US
Telephone Number	:	405-755-8866
Fax Number	:	405-755-8386

Provider Business Practice Location Address
First Line	:	13313 N MERIDIAN AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8316
Country	:	US
Telephone Number	:	405-755-8866
Fax Number	:	405-755-8386

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	07/09/2007

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