Provider Demographics
NPI:1952398398
Name:REINHART, KATHLEEN ANNE (DO)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANNE
Last Name:REINHART
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:14930 LAPLAISANCE RD
Mailing Address - Street 2:SUITE 127
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3880
Mailing Address - Country:US
Mailing Address - Phone:734-243-2510
Mailing Address - Fax:734-243-0957
Practice Address - Street 1:14930 LAPLAISANCE RD
Practice Address - Street 2:SUITE 127
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3880
Practice Address - Country:US
Practice Address - Phone:734-243-2510
Practice Address - Fax:734-243-0957
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007682208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2893002Medicaid
MI3555831714OtherBCBSM
MIM024026OtherCHAMPUS
MIM024026OtherCHAMPUS