Provider Demographics
NPI:1841292620
Name:REICHEL, TAYLOR F (MD)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:F
Last Name:REICHEL
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:PO BOX 1829
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83816-1829
Mailing Address - Country:US
Mailing Address - Phone:208-666-3200
Mailing Address - Fax:208-666-3397
Practice Address - Street 1:700 W IRONWOOD DR
Practice Address - Street 2:STE 110
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2656
Practice Address - Country:US
Practice Address - Phone:208-666-3200
Practice Address - Fax:208-666-3217
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM91152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8394751Medicaid
IDB0669OtherBC ID - RANI
ID806919400Medicaid
IDP00104435OtherRR MEDICARE - RANI
ID1122955OtherCIGNA MEDICARE - RANI
ID1122954Medicare ID - Type UnspecifiedCIGNA MEDICARE - NIIC
WA8394751Medicaid
IDP00104435OtherRR MEDICARE - RANI