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General NPI Number Information
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NPI Number | 1013081959
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Entity Type | Individual
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Provider Name | CARLOS MANUEL REYNES M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 7756 MADISON ST SUITE 8
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City | RIVER FOREST
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State | IL
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Zip | 60305-2058
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Country | US
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Telephone | 708-771-3471
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Fax | 708-771-2553
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Provider Business Mailing Address
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Address Line | 7756 MADISON ST SUITE 8
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City | RIVER FOREST
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State | IL
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Zip | 60305-2058
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Country | US
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Telephone | 708-771-3471
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Fax | 708-771-2553
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | IL
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