Provider Demographics
NPI:1740242247
Name:REISS, JEANNE E (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:E
Last Name:REISS
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:PO BOX 14250
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66285-4250
Mailing Address - Country:US
Mailing Address - Phone:913-438-2226
Mailing Address - Fax:913-438-2227
Practice Address - Street 1:373 W 101ST TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4408
Practice Address - Country:US
Practice Address - Phone:913-438-2226
Practice Address - Fax:913-438-2227
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR36102084N0600X
KS135602084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO03398167OtherBLUE SHIELD
MOQ571470Medicare PIN
MOQ570000Medicare PIN
MOC50629Medicare UPIN
KSQ57000AMedicare PIN
KSQ571470AMedicare PIN