Provider Demographics
NPI:1457490500
Name:REIERSON, KREEGAN JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:KREEGAN
Middle Name:JOHN
Last Name:REIERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-1309
Mailing Address - Country:US
Mailing Address - Phone:651-254-3456
Mailing Address - Fax:651-254-9673
Practice Address - Street 1:927 CHURCHILL ST W
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082-6605
Practice Address - Country:US
Practice Address - Phone:651-439-5330
Practice Address - Fax:651-430-4528
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2018-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN49356208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNI70277Medicare UPIN