Healthcare Provider Details

I. General information

NPI: 1225348626
Provider Name (Legal Business Name): KEVIN M REID D O INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2010
Last Update Date: 11/15/2010
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 Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number34002459R
License Number StateOH

VIII. Authorized Official

Name: KEVIN MICHAEL REID
Title or Position: PRESIDENT
Credential: D O
Phone: 937-226-7887