Healthcare Provider Details

I. General information

NPI: 1831223924
Provider Name (Legal Business Name): TOBI JEAN REIDY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 E STOP 11 RD STE 430
INDIANAPOLIS IN
46237-6341
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1479
US

V. Phone/Fax

Practice location:
  • Phone: 317-889-7906
  • Fax: 317-528-2286
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number58001917
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number02003638A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: