Provider Demographics
NPI:1023028859
Name:RICHARD P REINHERZ DPM & MARY G KWIECINSKI DPM PTR FAMILY FOOT CARE
Entity Type:Organization
Organization Name:RICHARD P REINHERZ DPM & MARY G KWIECINSKI DPM PTR FAMILY FOOT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:REINHERZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:847-816-3156
Mailing Address - Street 1:1641 N MILWAUKEE AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1350
Mailing Address - Country:US
Mailing Address - Phone:847-816-3156
Mailing Address - Fax:847-816-9724
Practice Address - Street 1:1641 N MILWAUKEE AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1350
Practice Address - Country:US
Practice Address - Phone:847-816-3156
Practice Address - Fax:847-816-9724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60001582OtherBLUE CROSS BLUE SHIELD
ILDG4210OtherMEDICARE RAILROAD
IL60001582OtherBLUE CROSS BLUE SHIELD
IL215591Medicare PIN