Provider Demographics
NPI:1548202609
Name:REINER, SAMUEL MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:MICHAEL
Last Name:REINER
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 1:725 RODEL CV
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4859
Mailing Address - Country:US
Mailing Address - Phone:407-302-3130
Mailing Address - Fax:407-302-3132
Practice Address - Street 1:725 RODEL CV
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4859
Practice Address - Country:US
Practice Address - Phone:407-302-3130
Practice Address - Fax:407-302-3132
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD45316207P00000X
FLME117512208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD593221100Medicaid
MD60609101OtherBLUE CROSS
FL009606700Medicaid
FL009606700Medicaid
MDF98574Medicare UPIN