Provider Demographics
NPI:1619914900
Name:POETSCHKE, REBECCA GRACE (DO)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:GRACE
Last Name:POETSCHKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E CUMMINS ST
Mailing Address - Street 2:
Mailing Address - City:TECUMSEH
Mailing Address - State:MI
Mailing Address - Zip Code:49286-2070
Mailing Address - Country:US
Mailing Address - Phone:517-423-9787
Mailing Address - Fax:517-423-7870
Practice Address - Street 1:501 E CUMMINS ST
Practice Address - Street 2:
Practice Address - City:TECUMSEH
Practice Address - State:MI
Practice Address - Zip Code:49286-2070
Practice Address - Country:US
Practice Address - Phone:517-423-9787
Practice Address - Fax:517-423-7870
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBP0096482084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2662328Medicaid
MI03681OtherPARAMOUNT HEALTH CARE
MI102407OtherGREAT LAKES HEALTH PLAN
MI511692OtherCARE CHOICES
MI2754615105OtherBLUE CROSS BLUE SHIELD
MI5714OtherHEALTH PLAN OF MICHIGAN
MI4515892OtherAETNA
MI2754615105OtherBLUE CROSS BLUE SHIELD
MI5714OtherHEALTH PLAN OF MICHIGAN