MEDICARE: DR. SAMUEL GREGORY REYES 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
1	208100000X	Physical Medicine & Rehabilitation Physician	125	IL
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1619649621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL GREGORY REYES MD

Provider Business Mailing Address
First Line	:	600 S PAULINA ST STE 403
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3806
Country	:	US
Telephone Number	:	312-563-7397
Fax Number	:

Provider Business Practice Location Address
First Line	:	1725 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3841
Country	:	US
Telephone Number	:	312-563-7397
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2021
Last Update Date	:	06/13/2026

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