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General NPI Number Information
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NPI Number | 1740628403
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Entity Type | Individual
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Provider Name | JOSEPH MICHAEL REYNOLDS D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2013
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 14700 W SAINT TERESA ST
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City | WICHITA
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State | KS
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Zip | 67235-9601
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Country | US
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Telephone | 316-274-0142
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Fax | 316-719-1033
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Provider Business Mailing Address
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Address Line | 901 S KANSAS AVE
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City | TOPEKA
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State | KS
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Zip | 66612-1210
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Country | US
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Telephone | 785-783-4080
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Fax | 833-673-0416
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 05-43611
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License Number State | KS
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