Provider Demographics
NPI:1437225935
Name:RIECH, ROBERT RYAN (MD, MPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:RYAN
Last Name:RIECH
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:IL
Mailing Address - Zip Code:61523-2059
Mailing Address - Country:US
Mailing Address - Phone:309-673-6464
Mailing Address - Fax:309-274-3120
Practice Address - Street 1:319 N 4TH ST
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:IL
Practice Address - Zip Code:61523-2059
Practice Address - Country:US
Practice Address - Phone:309-673-6464
Practice Address - Fax:309-274-3120
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060841A207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
809840OtherMEDICARE GROUP #
CA4079OtherRR MEDICARE GROUP #
P00406149OtherRR MEDICARE - INDIVIDUAL
IL036118731Medicaid
K40654Medicare PIN