1023028859 NPI number — RICHARD P REINHERZ DPM & MARY G KWIECINSKI DPM PTR FAMILY FOOT CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023028859 NPI number — RICHARD P REINHERZ DPM & MARY G KWIECINSKI DPM PTR FAMILY FOOT CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD P REINHERZ DPM & MARY G KWIECINSKI DPM PTR FAMILY FOOT CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023028859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1641 N MILWAUKEE AVE
Provider Second Line Business Mailing Address:
SUITE 14
Provider Business Mailing Address City Name:
LIBERTYVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60048-1350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-816-3156
Provider Business Mailing Address Fax Number:
847-816-9724

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1641 N MILWAUKEE AVE
Provider Second Line Business Practice Location Address:
SUITE 14
Provider Business Practice Location Address City Name:
LIBERTYVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60048-1350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-816-3156
Provider Business Practice Location Address Fax Number:
847-816-9724
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REINHERZ
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
847-816-3156

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 60001582 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: DG4210 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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