Healthcare Provider Details

I. General information

NPI: 1912059205
Provider Name (Legal Business Name): WILLIAM RANDALL REED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N HILLSIDE ST
WICHITA KS
67214-4910
US

IV. Provider business mailing address

550 N HILLSIDE ST
WICHITA KS
67214-4910
US

V. Phone/Fax

Practice location:
  • Phone: 316-962-8580
  • Fax: 316-962-8581
Mailing address:
  • Phone: 316-962-8580
  • Fax: 316-962-8581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number0420345
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: