Provider Demographics
NPI:1932544855
Name:REICHMUTH, MEGAN CHRISTINE (DO)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:CHRISTINE
Last Name:REICHMUTH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11885 E 12 MILE RD STE 300A
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3467
Mailing Address - Country:US
Mailing Address - Phone:586-582-6630
Mailing Address - Fax:586-582-6631
Practice Address - Street 1:1600 N GRAND AVE STE 140
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2755
Practice Address - Country:US
Practice Address - Phone:719-564-1542
Practice Address - Fax:719-566-0916
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0056740207RP1001X
MI5101020465207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty