MEDICARE: DR. PAUL REHKOPF 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	207P00000X	Emergency Medicine Physician	4301071274	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PR071274	OTHER	MI	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952351165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL REHKOPF M.D.

Provider Business Mailing Address
First Line	:	1917 ARGYLE AVE
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49008-2213
Country	:	US
Telephone Number	:	269-267-8358
Fax Number	:

Provider Business Practice Location Address
First Line	:	1917 ARGYLE AVE
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49008-2213
Country	:	US
Telephone Number	:	269-267-8358
Fax Number	:

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	12/20/2012

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