Healthcare Provider Details

I. General information

NPI: 1144243114
Provider Name (Legal Business Name): JULES REINHARDT D O PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1457 SUNCREST DR
LAPEER MI
48446-1151
US

IV. Provider business mailing address

1457 SUNCREST DR
LAPEER MI
48446-1151
US

V. Phone/Fax

Practice location:
  • Phone: 810-245-3629
  • Fax: 810-245-3640
Mailing address:
  • Phone: 810-245-3629
  • Fax: 810-245-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number5101004966
License Number StateMI

VIII. Authorized Official

Name: JULES LAWRENCE REINHARDT
Title or Position: PRESIDENT
Credential: D.O.
Phone: 810-245-3629