Provider Demographics
NPI:1710916101
Name:REINKE, MARTIN HELLMUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:HELLMUTH
Last Name:REINKE
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 1:1310 N WHITE CHAPEL BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-4308
Mailing Address - Country:US
Mailing Address - Phone:817-310-6080
Mailing Address - Fax:817-310-6014
Practice Address - Street 1:1310 N WHITE CHAPEL BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-4308
Practice Address - Country:US
Practice Address - Phone:817-310-6080
Practice Address - Fax:817-310-6014
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9560207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046418202Medicaid
TXG03458Medicare UPIN
TX8F1963Medicare PIN
TX046418202Medicaid