Provider Demographics
NPI:1861471278
Name:REICHENBACH, ERIC D (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:D
Last Name:REICHENBACH
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 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1104 N WAYNE ST
Practice Address - Street 2:
Practice Address - City:N MANCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46962-1001
Practice Address - Country:US
Practice Address - Phone:260-982-2102
Practice Address - Fax:260-982-2105
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01054724A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200346330AMedicaid
IN200346330AMedicaid
IN221600AMedicare PIN