Provider Demographics
NPI:1245236785
Name:REYNEN, MATTHEW C (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:REYNEN
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:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1460
Mailing Address - Country:US
Mailing Address - Phone:605-226-2663
Mailing Address - Fax:603-226-0095
Practice Address - Street 1:701 8TH AVENUE NW SUITE A
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401
Practice Address - Country:US
Practice Address - Phone:605-226-2663
Practice Address - Fax:603-226-0095
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4090207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6400770Medicaid
SDG27834Medicare UPIN
SD1108470001Medicare NSC
ND18913Medicare PIN
SD200024756Medicare PIN
ND20131Medicare PIN
SD6400770Medicaid
MN057521600Medicare PIN