Healthcare Provider Details

I. General information

NPI: 1407485964
Provider Name (Legal Business Name): KIRA LYNN REICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 12/23/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 W PARK ST FAPC
URBANA IL
61820
US

IV. Provider business mailing address

611 W PARK ST FAPC
URBANA IL
61820
US

V. Phone/Fax

Practice location:
  • Phone: 217-902-6954
  • Fax: 217-902-7711
Mailing address:
  • Phone: 217-902-6954
  • Fax: 217-902-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number036172017
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: