Provider Demographics
NPI:1457389389
Name:REUSSER, DAVID R (PA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:REUSSER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:50 INDUSTRIAL PARK RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013-1246
Mailing Address - Country:US
Mailing Address - Phone:269-427-7937
Mailing Address - Fax:269-427-5180
Practice Address - Street 1:6270 W MAIN ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:MI
Practice Address - Zip Code:49111-9480
Practice Address - Country:US
Practice Address - Phone:269-461-6927
Practice Address - Fax:269-461-3068
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI004528363A00000X
MI5601004528363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOTH000Medicare UPIN
MIN8281002Medicare PIN