Provider Demographics
NPI:1861693384
Name:REIGLE, FREDERICK C (M D)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:C
Last Name:REIGLE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:49252-9739
Mailing Address - Country:US
Mailing Address - Phone:517-542-3396
Mailing Address - Fax:
Practice Address - Street 1:208 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:MI
Practice Address - Zip Code:49252-9739
Practice Address - Country:US
Practice Address - Phone:517-542-3396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301023225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE3617Medicare UPIN