Provider Demographics
NPI:1649702333
Name:DEHAAN, REECE KRIST (MD)
Entity type:Individual
Prefix:
First Name:REECE
Middle Name:KRIST
Last Name:DEHAAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2566 HAYMAKER RD STE 304
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3555
Mailing Address - Country:US
Mailing Address - Phone:412-457-0040
Mailing Address - Fax:
Practice Address - Street 1:2566 HAYMAKER RD STE 304
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3555
Practice Address - Country:US
Practice Address - Phone:412-457-0040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD491335208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
16571924OtherCAQH
OH0218260Medicaid