Provider Demographics
NPI:1689802001
Name:REICHARDT, BRIAN AUGUST (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:AUGUST
Last Name:REICHARDT
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 1:1116 HARTMAN LN
Mailing Address - Street 2:
Mailing Address - City:SHILOH
Mailing Address - State:IL
Mailing Address - Zip Code:62221-8014
Mailing Address - Country:US
Mailing Address - Phone:618-641-9011
Mailing Address - Fax:618-641-9017
Practice Address - Street 1:3 SAINT ELIZABETH BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1281
Practice Address - Country:US
Practice Address - Phone:618-641-5803
Practice Address - Fax:618-607-5116
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL036-137965207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease