Provider Demographics
NPI:1144314162
Name:REYNERTSON, SANDRA IRENE (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:IRENE
Last Name:REYNERTSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:5TH AVENUE AND ROOSEVELT RD
Mailing Address - Street 2:MEDICINE NEUROLOGY SERVICE LINE (111)
Mailing Address - City:HINES
Mailing Address - State:IL
Mailing Address - Zip Code:60141
Mailing Address - Country:US
Mailing Address - Phone:708-202-4163
Mailing Address - Fax:708-202-1095
Practice Address - Street 1:5TH AVENUE AND ROOSEVELT RD
Practice Address - Street 2:MEDICINE NEUROLOGY SERVICE LINE (111)
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141
Practice Address - Country:US
Practice Address - Phone:708-202-4163
Practice Address - Fax:708-202-1095
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease