Provider Demographics
NPI:1639191992
Name:RESCHKE, DOBROSLAWA (MD)
Entity Type:Individual
Prefix:
First Name:DOBROSLAWA
Middle Name:
Last Name:RESCHKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 SADDLEBROOK LN
Mailing Address - Street 2:
Mailing Address - City:HANSON
Mailing Address - State:KY
Mailing Address - Zip Code:42413-9639
Mailing Address - Country:US
Mailing Address - Phone:270-322-0984
Mailing Address - Fax:
Practice Address - Street 1:201 S 14TH ST
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-3631
Practice Address - Country:US
Practice Address - Phone:618-942-2171
Practice Address - Fax:618-351-4917
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036106449207P00000X
IN01071900A207P00000X
KY41335207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3932056OtherBLUE SHIELD
KY000000545382OtherBCBS
KY7100017720Medicaid
IL$$$$$$$$$Medicaid
KY000000545382OtherBCBS
KYH99461Medicare UPIN
IL214881026Medicare PIN
KY00280017Medicare PIN