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NPI Code Detail

MEDICARE: MR. EDGARDO APOSTOL REYES JR. MD

MEDICARE: MR. EDGARDO APOSTOL REYES JR. 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
1207Q00000XFamily Medicine Physician036104492IL
2207Q00000XFamily Medicine Physician44348-020WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1VA D0000OTHERILUPIN NUMBER VA

General Provider Information

NPI Number : 1881715480
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EDGARDO APOSTOL REYES JR. MD
Provider Business Mailing Address
First Line : 4615 LINDBLOOM LN
Second Line :
City : CHERRY VALLEY
State : IL
Zip : 61016-9122
Country : US
Telephone Number : 815-580-8050
Fax Number :
Provider Business Practice Location Address
First Line : 816 FEATHERSTONE RD
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-6300
Country : US
Telephone Number : 815-227-0081
Fax Number : 815-387-5316
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/02/2007
Last Update Date : 03/26/2013

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