Provider Demographics
NPI:1033170949
Name:REINHEIMER, GARY ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:ANDREW
Last Name:REINHEIMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43750 GARFIELD RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-1135
Mailing Address - Country:US
Mailing Address - Phone:586-226-6865
Mailing Address - Fax:586-226-6880
Practice Address - Street 1:30795 23 MILE RD
Practice Address - Street 2:SUITE 209
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-5720
Practice Address - Country:US
Practice Address - Phone:586-948-0093
Practice Address - Fax:586-421-7500
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301046162207KA0200X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4373674Medicaid
MI4373807Medicaid
MI4704131Medicaid
MI4704131Medicaid
MIN40170030Medicare ID - Type UnspecifiedMEDICARE
MI4373674Medicaid