Provider Demographics
NPI:1477518017
Name:REHER, RANDALL LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:LEE
Last Name:REHER
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 1:42557 WOODWARD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-5206
Mailing Address - Country:US
Mailing Address - Phone:248-333-1170
Mailing Address - Fax:248-333-1175
Practice Address - Street 1:42557 WOODWARD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-5206
Practice Address - Country:US
Practice Address - Phone:248-333-1170
Practice Address - Fax:248-333-1175
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045118207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI19624787943OtherCOMMERCIAL
MI700F37550OtherBCN
MI700F37550OtherBCBSM
MI4411345Medicaid
MIE49574OtherHAP
MIM89900022Medicare PIN
MI700F37550OtherBCN