Provider Demographics
NPI:1295735371
Name:REINKE, LISA LOUISE (MD, PHARM D, RPH)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:LOUISE
Last Name:REINKE
Suffix:
Gender:F
Credentials:MD, PHARM D, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S PARK ST
Mailing Address - Street 2:4 TOWER
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-1507
Mailing Address - Country:US
Mailing Address - Phone:608-267-6676
Mailing Address - Fax:
Practice Address - Street 1:202 S PARK ST
Practice Address - Street 2:4TH TOWER
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1507
Practice Address - Country:US
Practice Address - Phone:608-267-6676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41306207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34257000Medicaid
H65177Medicare UPIN
WI34257000Medicaid