Provider Demographics
NPI:1669672549
Name:DR DANIEL G REUM DO PC
Entity Type:Organization
Organization Name:DR DANIEL G REUM DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-845-5069
Mailing Address - Street 1:5 N ATKINSON DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2918
Mailing Address - Country:US
Mailing Address - Phone:231-845-5069
Mailing Address - Fax:231-845-1332
Practice Address - Street 1:5 N ATKINSON DR
Practice Address - Street 2:SUITE 205
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-2918
Practice Address - Country:US
Practice Address - Phone:231-845-5069
Practice Address - Fax:231-845-1332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008973208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2687603Medicaid
MI5530009Medicare PIN
MI2687603Medicaid