Basic Information
| Provider Information | |||||||||
| NPI: | 1205835535 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REIMAN | ||||||||
| FirstName: | STEVE | ||||||||
| MiddleName: | ELLIOT | ||||||||
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| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 52375 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MATTAWAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490719332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2696683348 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 52375 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MATTAWAN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490719332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2696683348 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2005 | ||||||||
| LastUpdateDate: | 10/15/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5101011218 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 114993796 | 05 | MI | MEDICAID | 700H060020 | 01 | MI | BCBSM | OTHER | 1205835535 | 05 | MI | MEDICAID |