Healthcare Provider Details

I. General information

NPI: 1073514709
Provider Name (Legal Business Name): KEVIN M REID DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W GRAND AVE SUITE 2001
DAYTON OH
45405-4775
US

IV. Provider business mailing address

425 W GRAND AVE SUITE 2001
DAYTON OH
45405-4775
US

V. Phone/Fax

Practice location:
  • Phone: 937-226-7887
  • Fax: 937-224-5098
Mailing address:
  • Phone: 937-226-7887
  • Fax: 937-224-5098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number34002459R
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: