Provider Demographics
NPI:1093710741
Name:REESER, FREDERICK H (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:H
Last Name:REESER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:212 CHINABERRY LN
Mailing Address - Street 2:STE 901
Mailing Address - City:KIAWAH ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29455-5854
Mailing Address - Country:US
Mailing Address - Phone:414-333-5300
Mailing Address - Fax:
Practice Address - Street 1:2600 N MAYFAIR RD
Practice Address - Street 2:STE 901
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-1307
Practice Address - Country:US
Practice Address - Phone:414-774-3484
Practice Address - Fax:414-778-3445
Is Sole Proprietor?:No
Enumeration Date:2005-06-18
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI18419207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI82052OtherCHILDRENS COMM HEALTH
WI30939600Medicaid
MN560162200Medicaid
WI000201702Medicare ID - Type UnspecifiedMILW CNTY
WIB55974Medicare UPIN
WI000145250Medicare ID - Type UnspecifiedAPPLETON CNTY
WI82052OtherCHILDRENS COMM HEALTH
180012022Medicare ID - Type UnspecifiedRAILROAD MEDICARE