MEDICARE: DR. STEVEN REPPUHN PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301006233	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	037196	OTHER	MI	MAGELLAN
2	11286845	OTHER	MI	CAQH ID
3	680B44503	OTHER	MI	BCBS ID

General Provider Information

NPI Number	:	1033265756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN REPPUHN PH.D.

Provider Business Mailing Address
First Line	:	03198 REYCRAFT
Second Line	:
City	:	BOYNE CITY
State	:	MI
Zip	:	49712
Country	:	US
Telephone Number	:	231-347-0456
Fax Number	:	231-348-0800

Provider Business Practice Location Address
First Line	:	2810 CHARLEVOIX AVE STE 102
Second Line	:	ARROWHEAD COMMONS
City	:	PETOSKEY
State	:	MI
Zip	:	49770-8421
Country	:	US
Telephone Number	:	231-347-6542
Fax Number	:	231-348-0800

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. STEVEN REPPUHN PH.D.” Practice Location

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