Provider Demographics
NPI:1023118981
Name:RIEHN, DAVID G (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:RIEHN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742318
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2318
Mailing Address - Country:US
Mailing Address - Phone:317-614-9863
Mailing Address - Fax:
Practice Address - Street 1:6201 N SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428-6712
Practice Address - Country:US
Practice Address - Phone:352-795-4008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS11146207L00000X
MI5101010556207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4471370-11Medicaid
FL003277000Medicaid
FLER333ZOtherMEDICARE
FL003277000Medicaid
MI050091416Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MI4471370-11Medicaid