Provider Demographics
NPI:1407840077
Name:RIEMANN, DAVID WAYNE (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WAYNE
Last Name:RIEMANN
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:PO BOX 2034
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43603-2034
Mailing Address - Country:US
Mailing Address - Phone:440-233-8181
Mailing Address - Fax:440-233-8182
Practice Address - Street 1:6125 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3820
Practice Address - Country:US
Practice Address - Phone:440-233-8181
Practice Address - Fax:440-233-8182
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004551R207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0821650Medicaid
OHE87772Medicare UPIN
OH0694105Medicare PIN