Provider Demographics
NPI:1295703346
Name:SUSAN REISINGER, MD PROF. CORP.
Entity type:Organization
Organization Name:SUSAN REISINGER, MD PROF. CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHROADER
Authorized Official - Suffix:
Authorized Official - Credentials:CREDENTIALING
Authorized Official - Phone:602-932-8288
Mailing Address - Street 1:PO BOX 745059
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-5059
Mailing Address - Country:US
Mailing Address - Phone:702-508-9944
Mailing Address - Fax:702-508-9944
Practice Address - Street 1:2851 N TENAYA WAY STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0453
Practice Address - Country:US
Practice Address - Phone:702-243-3340
Practice Address - Fax:702-228-4724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506274Medicaid
NV100506274Medicaid
CAXGG007543Medicaid
CAXGG007541Medicaid
CAXGG007542Medicaid
CAXGG007540Medicaid