MEDICARE: MICHAEL JACK REHR DO

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	207R00000X	Internal Medicine Physician	OT014660	PA
2	390200000X	Student in an Organized Health Care Education/Training Program	OT014660	PA

General Provider Information

NPI Number	:	1770842064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL JACK REHR DO

Provider Business Mailing Address
First Line	:	800 SPRUCE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-6130
Country	:	US
Telephone Number	:	215-829-5410
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 SPRUCE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-6130
Country	:	US
Telephone Number	:	215-829-5410
Fax Number	:

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

Provider Enumeration Date	:	05/08/2012
Last Update Date	:	05/08/2012

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