Provider Demographics
NPI:1497825863
Name:REINERTSON, ERIC VINCENT (M D)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:VINCENT
Last Name:REINERTSON
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-3905
Mailing Address - Country:US
Mailing Address - Phone:309-478-1700
Mailing Address - Fax:309-478-1701
Practice Address - Street 1:2401 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3905
Practice Address - Country:US
Practice Address - Phone:309-478-1700
Practice Address - Fax:309-478-1701
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-097075207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL9032006OtherBLUE CROSS BLUE SHIELD
IL036097075Medicaid
IL9032006OtherBLUE CROSS BLUE SHIELD
ILF81825Medicare UPIN