Provider Demographics
NPI:1669769204
Name:REETER, AMY R (DPM)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:R
Last Name:REETER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:R
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:101 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:HERRIN
Mailing Address - State:IL
Mailing Address - Zip Code:62948-1750
Mailing Address - Country:US
Mailing Address - Phone:618-988-6034
Mailing Address - Fax:
Practice Address - Street 1:101 N 16TH ST
Practice Address - Street 2:
Practice Address - City:HERRIN
Practice Address - State:IL
Practice Address - Zip Code:62948-1750
Practice Address - Country:US
Practice Address - Phone:618-988-6034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-04
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016005593213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016005593OtherLICENSE