Provider Demographics
NPI:1972762631
Name:REESE SURGICAL GROUP PLLC
Entity Type:Organization
Organization Name:REESE SURGICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:952-922-4247
Mailing Address - Street 1:6525 FRANCE AVE S
Mailing Address - Street 2:SUITE 305
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2148
Mailing Address - Country:US
Mailing Address - Phone:952-922-4247
Mailing Address - Fax:952-884-8109
Practice Address - Street 1:6525 FRANCE AVE S
Practice Address - Street 2:SUITE 305
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2148
Practice Address - Country:US
Practice Address - Phone:952-922-4247
Practice Address - Fax:952-884-8109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN422442086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1134152085OtherTYPE I NPI
MNF60835Medicare UPIN