Provider Demographics
NPI:1417370602
Name:REISWIG AESTHETICS SC
Entity Type:Organization
Organization Name:REISWIG AESTHETICS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:REISWIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:414-526-1291
Mailing Address - Street 1:1233 N MAYFAIR RD STE 208
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3255
Mailing Address - Country:US
Mailing Address - Phone:414-526-1291
Mailing Address - Fax:
Practice Address - Street 1:1233 N MAYFAIR RD STE 208
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-3255
Practice Address - Country:US
Practice Address - Phone:414-526-1291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52720-20261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service