Provider Demographics
NPI:1285809731
Name:KATHLEEN REINHART DO PC
Entity type:Organization
Organization Name:KATHLEEN REINHART DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:REINHART
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-243-2510
Mailing Address - Street 1:14930 LAPLAISANCE RD STE 127
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-3878
Mailing Address - Country:US
Mailing Address - Phone:734-243-2510
Mailing Address - Fax:734-243-0957
Practice Address - Street 1:14930 LAPLAISANCE RD STE 127
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-3878
Practice Address - Country:US
Practice Address - Phone:734-243-2510
Practice Address - Fax:734-243-0957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007682208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2893002Medicaid