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Individual
THEODORE K REAHM
Active
Individual
THEODORE K REAHM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
TR013953
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0857124294
BLUE CARE NETWORK
MI
05
—
4943535
—
MI
01
—
P00342248
RAILROAD MEDICARE
MI
Enumeration date
05/23/2006
Last updated
04/03/2008
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