Healthcare Provider Details

I. General information

NPI: 1063410132
Provider Name (Legal Business Name): KEVIN EUGENE REILLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6909 GOOD SAMARITAN DRIVE SUITE A
CINCINNATI OH
45247-5207
US

IV. Provider business mailing address

4701 CREEK ROAD SUITE 110
CINCINNATI OH
45242
US

V. Phone/Fax

Practice location:
  • Phone: 513-245-2500
  • Fax: 513-245-5424
Mailing address:
  • Phone: 513-618-9011
  • Fax: 513-588-2479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number35068341
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: