MEDICARE: DR. RICHARD S REIKOWSKI AU.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
1	231H00000X	Audiologist	A01056	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	311534810RS	OTHER	OH	SUMMA - FHC
2	000000121488	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1720165848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD S REIKOWSKI AU.D.

Provider Business Mailing Address
First Line	:	920 WALTER CT
Second Line	:
City	:	TALLMADGE
State	:	OH
Zip	:	44278-1648
Country	:	US
Telephone Number	:	330-633-0140
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 S ARLINGTON RD
Second Line	:	STE 102
City	:	AKRON
State	:	OH
Zip	:	44312-4702
Country	:	US
Telephone Number	:	330-644-1932
Fax Number	:	330-475-0780

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/07/2014

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