Healthcare Provider Details

I. General information

NPI: 1134120389
Provider Name (Legal Business Name): JOSELITO C REYES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6745 W 63RD ST
CHICAGO IL
60638-4003
US

IV. Provider business mailing address

6745 W 63RD ST
CHICAGO IL
60638-4003
US

V. Phone/Fax

Practice location:
  • Phone: 773-229-2373
  • Fax: 773-229-2376
Mailing address:
  • Phone: 773-229-2373
  • Fax: 773-229-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036077248
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number036-077248
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: