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NPI Code Detail

MEDICARE: DR. OMAR RIECHE M.D.

MEDICARE: DR. OMAR RIECHE M.D.
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
12084P0804XChild & Adolescent Psychiatry PhysicianME63632FL
22084P0800XPsychiatry PhysicianME63632FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629162813
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. OMAR RIECHE M.D.
Provider Business Mailing Address
First Line : 4310 METRO PKWY STE 205
Second Line :
City : FORT MYERS
State : FL
Zip : 33916-9416
Country : US
Telephone Number : 239-223-2751
Fax Number : 239-561-2933
Provider Business Practice Location Address
First Line : 4310 METRO PKWY STE 205
Second Line :
City : FORT MYERS
State : FL
Zip : 33916-9416
Country : US
Telephone Number : 239-223-2751
Fax Number : 239-561-2933
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 04/14/2020

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