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General NPI Number Information
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NPI Number | 1366469991
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Entity Type | Individual
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Provider Name | JOSE REYES M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 1800 E LAKE SHORE DR
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City | DECATUR
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State | IL
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Zip | 62521-3810
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Country | US
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Telephone | 217-464-2966
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Fax |
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Provider Business Mailing Address
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Address Line | 75 REMITT DRIVE LOCKBOX 1707
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City | CHICAGO
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State | IL
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Zip | 60675-1707
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Country | US
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Telephone | 866-916-5259
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Fax | 231-922-4030
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 25MA05453400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State | IL
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