Healthcare Provider Details

I. General information

NPI: 1447298971
Provider Name (Legal Business Name): CHRISTIE M REAGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 MILLIS AVE SUITE 201A
BOONVILLE IN
47601-2204
US

IV. Provider business mailing address

1116 MILLIS AVE STE 101
BOONVILLE IN
47601-2226
US

V. Phone/Fax

Practice location:
  • Phone: 812-897-7381
  • Fax: 812-897-7331
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01059425A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01059425A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: