Provider Demographics
NPI:1982619623
Name:REINKE, ANNA LINN (PA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:LINN
Last Name:REINKE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 FOXFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5799
Mailing Address - Country:US
Mailing Address - Phone:630-513-8275
Mailing Address - Fax:630-513-9208
Practice Address - Street 1:2900 FOXFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-5799
Practice Address - Country:US
Practice Address - Phone:630-513-8275
Practice Address - Fax:630-513-9208
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006022432207RC0000X
IL085002341363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL920540OtherMEDICARE PTAN (GROUP)
IL920540013OtherMEDICARE PTAN (INDIVIDUAL)
ILK11935Medicare ID - Type UnspecifiedMEDICARE
IL920540OtherMEDICARE PTAN (GROUP)