Provider Demographics
NPI:1891740379
Name:REAHM, THEODORE K (DO)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:K
Last Name:REAHM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:920 S HURON STREET
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721
Mailing Address - Country:US
Mailing Address - Phone:231-597-8192
Mailing Address - Fax:231-597-8463
Practice Address - Street 1:3570 1/2 N VETERENS DRIVE
Practice Address - Street 2:
Practice Address - City:ONAWAY
Practice Address - State:MI
Practice Address - Zip Code:49765
Practice Address - Country:US
Practice Address - Phone:989-733-4045
Practice Address - Fax:989-733-4046
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MITR013953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0857124294OtherBLUE CARE NETWORK
MIP00342248OtherRAILROAD MEDICARE
MI0857124294OtherBCBS
MI4943535Medicaid
H41220Medicare UPIN
MI0857124294OtherBCBS