Individual
RICHARD MAST REINHARD III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1276 N CLYBOURN AVE, CHICAGO, IL 60610-2089
(312) 337-1073
(312) 337-7616
Mailing address
1276 N CLYBOURN AVE, CHICAGO, IL 60610-2003
(312) 337-1073
(312) 337-7616
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036.168144
IL
208000000X
Pediatrics Physician
58522
TN
208000000X
Pediatrics Physician
E-2211
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136436001
—
AR
01
—
18311000000
QUALCHOICE NUMBER
AR
01
—
5L125
BLUE CROSS NUMBER
AR
Enumeration date
08/15/2005
Last updated
02/26/2024
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