Provider Demographics
NPI:1508862129
Name:REICHERT & KELSEY PROSTHETICS ORTHOTICS LLC
Entity Type:Organization
Organization Name:REICHERT & KELSEY PROSTHETICS ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:REICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:262-654-4300
Mailing Address - Street 1:5027 GREEN BAY RD
Mailing Address - Street 2:STE 124
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-1771
Mailing Address - Country:US
Mailing Address - Phone:262-654-4300
Mailing Address - Fax:262-654-4305
Practice Address - Street 1:5027 GREEN BAY RD
Practice Address - Street 2:STE 124
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-1771
Practice Address - Country:US
Practice Address - Phone:262-654-4300
Practice Address - Fax:262-654-4305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI81892OtherNPN
WI24746OtherABP
WI41789200Medicaid
WI41789200Medicaid
WI81892OtherNPN
WI41789200Medicaid