Provider Demographics
NPI:1417537895
Name:REEB, ISAAC CHRISTIAN (RD)
Entity Type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:CHRISTIAN
Last Name:REEB
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6735 PINELAKE DR APT 101
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-5658
Mailing Address - Country:US
Mailing Address - Phone:920-222-9257
Mailing Address - Fax:
Practice Address - Street 1:422 W JOHNSON ST APT 5
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-5005
Practice Address - Country:US
Practice Address - Phone:920-222-9257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered