MEDICARE: DR. MARK V REICHMAN 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
1	207T00000X	Neurological Surgery Physician	1732781205	UT

Other Identifiers

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

General Provider Information

NPI Number	:	1942260617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK V REICHMAN M.D.

Provider Business Mailing Address
First Line	:	2191 E PHEASANT WAY
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84121-1310
Country	:	US
Telephone Number	:	801-403-3074
Fax Number	:

Provider Business Practice Location Address
First Line	:	5171 COTTONWOOD ST
Second Line	:	SUITE 950
City	:	MURRAY
State	:	UT
Zip	:	84107-5704
Country	:	US
Telephone Number	:	801-507-9555
Fax Number	:	801-507-9550

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

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	08/16/2024

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