Healthcare Provider Details

I. General information

NPI: 1679536007
Provider Name (Legal Business Name): MICHAEL J REICHERTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4043 S ROUTE 59
NAPERVILLE IL
60564-5802
US

IV. Provider business mailing address

4043 S ROUTE 59
NAPERVILLE IL
60564-5802
US

V. Phone/Fax

Practice location:
  • Phone: 630-420-4275
  • Fax: 630-420-8957
Mailing address:
  • Phone: 630-420-4275
  • Fax: 630-420-8957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036091664
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier036091664
Identifier TypeMEDICAID
Identifier StateIL
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: