Provider Demographics
NPI:1366601536
Name:KAPTEYN, REGINALD W (DO)
Entity type:Individual
Prefix:
First Name:REGINALD
Middle Name:W
Last Name:KAPTEYN
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 1:1400 MERCY DR.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444
Mailing Address - Country:US
Mailing Address - Phone:231-830-2729
Mailing Address - Fax:231-733-5212
Practice Address - Street 1:1400 MERCY DR.
Practice Address - Street 2:SUITE 100
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444
Practice Address - Country:US
Practice Address - Phone:231-830-2729
Practice Address - Fax:231-733-5212
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI38-2192991208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2996718Medicaid
OH4278544Medicare PIN