Provider Demographics
NPI:1851396246
Name:REICHEL, JEFFREY K (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:K
Last Name:REICHEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JEFFREY
Other - Middle Name:K
Other - Last Name:REICHEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:201 N MAYFAIR RD
Mailing Address - Street 2:STE 505
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4216
Mailing Address - Country:US
Mailing Address - Phone:414-258-7799
Mailing Address - Fax:414-258-9021
Practice Address - Street 1:201 N MAYFAIR RD
Practice Address - Street 2:STE 505
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4216
Practice Address - Country:US
Practice Address - Phone:414-258-7799
Practice Address - Fax:414-258-9021
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32501207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30058000Medicaid
WI80504Medicare ID - Type UnspecifiedMEDICARE
WI30058000Medicaid