Healthcare Provider Details

I. General information

NPI: 1366672834
Provider Name (Legal Business Name): REENA THOMAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2009
Last Update Date: 05/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 SAINT FRANCIS DR
CAPE GIRARDEAU MO
63703-5049
US

IV. Provider business mailing address

PO BOX 843225
KANSAS CITY MO
64184-3225
US

V. Phone/Fax

Practice location:
  • Phone: 573-331-5176
  • Fax: 573-331-5089
Mailing address:
  • Phone: 708-633-1234
  • Fax: 708-342-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20090199841
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036122146
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2009019841
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036122146
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: