Provider Demographics
NPI:1205835535
Name:REIMAN, STEVE ELLIOT (DO)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:ELLIOT
Last Name:REIMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52375 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-9332
Mailing Address - Country:US
Mailing Address - Phone:269-668-3348
Mailing Address - Fax:
Practice Address - Street 1:52375 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MATTAWAN
Practice Address - State:MI
Practice Address - Zip Code:49071-9332
Practice Address - Country:US
Practice Address - Phone:269-668-3348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011218207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114993796Medicaid
MI700H060020OtherBCBSM
MI1205835535Medicaid
MI114993796Medicaid
MI700H060020OtherBCBSM