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NPI Code Detail

MEDICARE: DR. CHRISTIE M REAGAN MD

MEDICARE: DR. CHRISTIE M REAGAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician01059425AIN
2207P00000XEmergency Medicine Physician01059425AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000339553OTHERINANTHEM PROVIDER#
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447298971
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRISTIE M REAGAN MD
Provider Business Mailing Address
First Line : 1116 MILLIS AVE STE 101
Second Line :
City : BOONVILLE
State : IN
Zip : 47601-2226
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1116 MILLIS AVE
Second Line : SUITE 201A
City : BOONVILLE
State : IN
Zip : 47601-2204
Country : US
Telephone Number : 812-897-7381
Fax Number : 812-897-7331
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2006
Last Update Date : 08/10/2022

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Directions to “ DR. CHRISTIE M REAGAN MD” Practice Location

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