Provider Demographics
NPI:1710510391
Name:REINHART, MICHAELA ROSE (PA-C)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:ROSE
Last Name:REINHART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W NORTH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-1677
Mailing Address - Country:US
Mailing Address - Phone:708-450-5096
Mailing Address - Fax:708-345-4075
Practice Address - Street 1:501 W NORTH AVE STE 103
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1677
Practice Address - Country:US
Practice Address - Phone:708-450-5086
Practice Address - Fax:708-345-4075
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085007520363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant