Healthcare Provider Details

I. General information

NPI: 1891740379
Provider Name (Legal Business Name): THEODORE K REAHM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 04/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3570 1/2 N VETERENS DRIVE
ONAWAY MI
49765
US

IV. Provider business mailing address

920 S HURON STREET
CHEBOYGAN MI
49721
US

V. Phone/Fax

Practice location:
  • Phone: 989-733-4045
  • Fax: 989-733-4046
Mailing address:
  • Phone: 231-597-8192
  • Fax: 231-597-8463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTR013953
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: