Provider Demographics
NPI:1508843095
Name:REINHARD, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:REINHARD
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 1:4084 N US HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:CHURUBUSCO
Practice Address - State:IN
Practice Address - Zip Code:46723-9563
Practice Address - Country:US
Practice Address - Phone:260-373-9595
Practice Address - Fax:260-373-9599
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060240A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000364622OtherANTHEM
INP00349632OtherRAILROAD MEDICARE
IN3937240016OtherMEDICARE DMEPOS
IN3937240025OtherMEDICARE DMEPOS
IN17795OtherPHYSICIANS HEALTH PLAN
IN200518840Medicaid
5733017OtherAETNA
IN000000570554OtherANTHEM
IN070860EEEMedicare PIN
IN17795OtherPHYSICIANS HEALTH PLAN
5733017OtherAETNA
IN3937240025OtherMEDICARE DMEPOS
IN3937240016OtherMEDICARE DMEPOS
IN200518840Medicaid