Provider Demographics
NPI:1801258397
Name:REISINGER-KINDLE, KEITH MICHAEL (DO, MPH, MS)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:MICHAEL
Last Name:REISINGER-KINDLE
Suffix:
Gender:M
Credentials:DO, MPH, MS
Other - Prefix:MR
Other - First Name:KEITH
Other - Middle Name:MICHAEL
Other - Last Name:REISINGER
Other - Suffix:II
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2111 W PARK CT
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-2986
Mailing Address - Country:US
Mailing Address - Phone:224-350-2973
Mailing Address - Fax:224-350-2990
Practice Address - Street 1:725 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45324-2640
Practice Address - Country:US
Practice Address - Phone:937-245-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.014333207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology