Provider Demographics
NPI:1528378015
Name:JOHN PAUL REHEIS, MD LLC
Entity Type:Organization
Organization Name:JOHN PAUL REHEIS, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:REHEIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-741-8320
Mailing Address - Street 1:15 PALOMBA DR
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-3888
Mailing Address - Country:US
Mailing Address - Phone:860-741-8320
Mailing Address - Fax:860-741-8417
Practice Address - Street 1:15 PALOMBA DR
Practice Address - Street 2:SUITE 11
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-3888
Practice Address - Country:US
Practice Address - Phone:860-741-8320
Practice Address - Fax:860-741-8417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040737208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty