Provider Demographics
NPI:1952484768
Name:REIFF, MICHAEL I (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:I
Last Name:REIFF
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 1:280 CHESTNUT STREET 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:50 WASON AVENUE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107
Practice Address - Country:US
Practice Address - Phone:413-794-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA35536208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0065331Medicaid
MN112164OtherUCARE
MN008580400Medicaid
MN1016806OtherPREFERRED ONE
MN12-02472OtherMEDICA CHOICE
MN12-09026OtherMEDICA PRIMARY
MN785186OtherARAZ
MNHP30558OtherHEALTH PARTNERS
A47485Medicare UPIN
370002642Medicare ID - Type Unspecified