Provider Demographics
NPI:1477863942
Name:MICHAEL J RIERMAIER MD JD SC
Entity Type:Organization
Organization Name:MICHAEL J RIERMAIER MD JD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNM/OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:847-697-7722
Mailing Address - Street 1:1435 N RANDALL RD
Mailing Address - Street 2:STE 304
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123
Mailing Address - Country:US
Mailing Address - Phone:847-697-7722
Mailing Address - Fax:847-697-7852
Practice Address - Street 1:1435 N RANDALL RD
Practice Address - Street 2:STE 304
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:847-697-7722
Practice Address - Fax:847-697-7852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065268207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036065268Medicaid
201498Medicare PIN
ILC38286Medicare UPIN