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NPI Code Detail

MEDICARE: MICHAEL J REILLY MD

MEDICARE:   MICHAEL J REILLY  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician0423611KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
217552018OTHERBLUE CROSS BLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1053310904
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL J REILLY MD
Provider Business Mailing Address
First Line : PO BOX 716
Second Line :
City : OVERLAND PARK
State : KS
Zip : 66201-0716
Country : US
Telephone Number : 913-791-4357
Fax Number : 913-791-4435
Provider Business Practice Location Address
First Line : 20333 W 151ST ST
Second Line :
City : OLATHE
State : KS
Zip : 66061-5350
Country : US
Telephone Number : 913-791-4357
Fax Number : 913-791-4435
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2005
Last Update Date : 08/08/2011

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