MEDICARE: MR. DOUGLAS E REICHERT CP

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	224P00000X	Prosthetist		IL

General Provider Information

NPI Number	:	1376549980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DOUGLAS E REICHERT CP

Provider Business Mailing Address
First Line	:	5027 GREEN BAY RD
Second Line	:	STE 124
City	:	KENOSHA
State	:	WI
Zip	:	53144-1771
Country	:	US
Telephone Number	:	262-654-4300
Fax Number	:	262-654-4305

Provider Business Practice Location Address
First Line	:	5027 GREEN BAY RD
Second Line	:	STE 124
City	:	KENOSHA
State	:	WI
Zip	:	53144-1771
Country	:	US
Telephone Number	:	262-654-4300
Fax Number	:	262-654-4305

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

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	07/08/2007

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