Provider Demographics
NPI:1477541423
Name:REIN, MICHELLE L (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:REIN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:LEE
Other - Last Name:GLENNA REIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 860912
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0912
Mailing Address - Country:US
Mailing Address - Phone:608-785-0940
Mailing Address - Fax:
Practice Address - Street 1:701 N SPRAGUE ST
Practice Address - Street 2:
Practice Address - City:CALEDONIA
Practice Address - State:MN
Practice Address - Zip Code:55921-1066
Practice Address - Country:US
Practice Address - Phone:507-725-3353
Practice Address - Fax:507-724-5650
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49143207Q00000X
WI44877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H75053Medicare UPIN