Provider Demographics
NPI:1982668448
Name:REAUME, DARRYL R (DO)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:R
Last Name:REAUME
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31157 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-0996
Mailing Address - Country:US
Mailing Address - Phone:248-969-0665
Mailing Address - Fax:
Practice Address - Street 1:10442 HASTINGS CT
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-2196
Practice Address - Country:US
Practice Address - Phone:248-969-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011321208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3381303-11Medicaid
MIG58286Medicare UPIN