Basic Information
| Provider Information | |||||||||
| NPI: | 1588601603 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REUT | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6465 WAYZATA BLVD | ||||||||
| Address2: | SUITE 900 | ||||||||
| City: | ST LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554261728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525125600 | ||||||||
| FaxNumber: | 9525125650 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 PLYMOUTH RD | ||||||||
| Address2: | RIDGEHILL PROFESSIONAL BUILD STE 110 | ||||||||
| City: | MINNETONKA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553052366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9527672430 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 07/11/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 38649 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 124011 | 01 | MEDICA | OTHER | 969991010913 | 01 | PREFERREDONE | OTHER | HP18961 | 01 | HEALTHPARTNERS | OTHER | 116H3RE | 01 | BLUECROSS BLUESHIELD | OTHER | 111721E948 | 01 | UCARE | OTHER |