Provider Demographics
NPI:1083665707
Name:REINDERS, DONALD B (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:B
Last Name:REINDERS
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 1:230 W OAK ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-1575
Mailing Address - Country:US
Mailing Address - Phone:231-924-4200
Mailing Address - Fax:231-924-2001
Practice Address - Street 1:230 W OAK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1575
Practice Address - Country:US
Practice Address - Phone:231-924-4200
Practice Address - Fax:231-924-2001
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI032472207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1368957Medicaid
MIF26007004Medicare ID - Type UnspecifiedMEDICARE NUMBER
MI1368957Medicaid