Healthcare Provider Details

I. General information

NPI: 1538467683
Provider Name (Legal Business Name): KASEY REYNOLDS MARELIC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASEY AILEEN REYNOLDS

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 05/21/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8845 LYRA DR
COLUMBUS OH
43240
US

IV. Provider business mailing address

333 S DESPLAINES ST STE 201
CHICAGO IL
60661-5514
US

V. Phone/Fax

Practice location:
  • Phone: 380-222-2731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD500002958
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberME166195
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number97275
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number036.166990
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number01092222A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberC1920
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number33258
License Number StateWV
# 8
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number35123721
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: