Healthcare Provider Details

I. General information

NPI: 1861597387
Provider Name (Legal Business Name): THOMAS M. REILLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 05/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 N DIXON RD
KOKOMO IN
46901-1754
US

IV. Provider business mailing address

13225 N MERIDIAN ST
CARMEL IN
46032-5480
US

V. Phone/Fax

Practice location:
  • Phone: 765-450-0111
  • Fax: 765-553-5504
Mailing address:
  • Phone: 317-228-7000
  • Fax: 317-228-2321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number01047334A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: