Provider Demographics
NPI:1043211766
Name:REIM, REBECCA M (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:REIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:REEDSBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53959-1655
Mailing Address - Country:US
Mailing Address - Phone:608-768-6767
Mailing Address - Fax:
Practice Address - Street 1:226 N PINE ST
Practice Address - Street 2:
Practice Address - City:REEDSBURG
Practice Address - State:WI
Practice Address - Zip Code:53959-1655
Practice Address - Country:US
Practice Address - Phone:608-768-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46302207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34639800Medicaid
WIP00263226OtherRAILROAD MEDICARE
AK1629107Medicaid
WI528513OtherUGS MEDICARE
WI528513OtherUGS MEDICARE
AK1629107Medicaid
WI34639800Medicaid
I30882Medicare UPIN