Provider Demographics
NPI:1972579233
Name:REINKING, BENJAMIN EVERS (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:EVERS
Last Name:REINKING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BEN
Other - Middle Name:E
Other - Last Name:REINKING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-6360
Mailing Address - Fax:319-384-9184
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-6360
Practice Address - Fax:319-384-9184
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA351242080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0448811Medicaid
IA37514OtherWELLMARK BCBS
I21489Medicare UPIN
IA0448811Medicaid