MEDICARE: MS. LEE REYNOLDS

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	35.143313	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912439845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEE REYNOLDS

Provider Business Mailing Address
First Line	:	128 E APPLE ST
Second Line	:	WCHE 7TH FLOOR
City	:	DAYTON
State	:	OH
Zip	:	45409-2902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8240 NORTHCREEK DR STE 3000
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-0709
Country	:	US
Telephone Number	:	513-246-7000
Fax Number	:	513-246-5309

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

Provider Enumeration Date	:	03/30/2017
Last Update Date	:	03/09/2022

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