Healthcare Provider Details

I. General information

NPI: 1962442467
Provider Name (Legal Business Name): DANIEL J. REINKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 UNION ST
ELLSWORTH ME
04605
US

IV. Provider business mailing address

50 UNION ST
ELLSWORTH ME
04605
US

V. Phone/Fax

Practice location:
  • Phone: 207-664-5304
  • Fax: 207-664-5305
Mailing address:
  • Phone: 207-664-5304
  • Fax: 207-664-5305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number014303
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: