Provider Demographics
NPI:1629201876
Name:REINOEHL, BRUCE MILLER (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:MILLER
Last Name:REINOEHL
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 1:10411 BOND RD
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:MI
Mailing Address - Zip Code:48820-9781
Mailing Address - Country:US
Mailing Address - Phone:517-669-5486
Mailing Address - Fax:
Practice Address - Street 1:10411 BOND RD
Practice Address - Street 2:
Practice Address - City:DEWITT
Practice Address - State:MI
Practice Address - Zip Code:48820-9781
Practice Address - Country:US
Practice Address - Phone:517-669-5486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301037831207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB47806Medicare UPIN