MEDICARE: RICHARD CHARLES REUT D.O.

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	207QS0010X	Sports Medicine (Family Medicine) Physician	38649	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	124011	OTHER	MEDICA
2	969991010913	OTHER	PREFERREDONE
3	HP18961	OTHER	HEALTHPARTNERS
4	116H3RE	OTHER	BLUECROSS BLUESHIELD
5	111721E948	OTHER	UCARE

General Provider Information

NPI Number	:	1588601603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD CHARLES REUT D.O.

Provider Business Mailing Address
First Line	:	6465 WAYZATA BLVD
Second Line	:	SUITE 900
City	:	ST LOUIS PARK
State	:	MN
Zip	:	55426-1728
Country	:	US
Telephone Number	:	952-512-5600
Fax Number	:	952-512-5650

Provider Business Practice Location Address
First Line	:	2000 PLYMOUTH RD
Second Line	:	RIDGEHILL PROFESSIONAL BUILD STE 110
City	:	MINNETONKA
State	:	MN
Zip	:	55305-2366
Country	:	US
Telephone Number	:	952-767-2430
Fax Number	:

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/11/2007

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