MEDICARE: MICHAEL GEORGE REYNOLDS M.D.

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
1	174400000X	Specialist	04-24388	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	47-1424576	OTHER	TAX ID
3	48-0792406	OTHER	OLD TAX ID

General Provider Information

NPI Number	:	1760486526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL GEORGE REYNOLDS M.D.

Provider Business Mailing Address
First Line	:	1602 W 15TH AVE
Second Line	:	STE B
City	:	EMPORIA
State	:	KS
Zip	:	66801-5672
Country	:	US
Telephone Number	:	620-342-6989
Fax Number	:	620-342-2262

Provider Business Practice Location Address
First Line	:	1602 W 15TH AVE
Second Line	:	STE B
City	:	EMPORIA
State	:	KS
Zip	:	66801-5672
Country	:	US
Telephone Number	:	620-342-6989
Fax Number	:	620-342-2262

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	08/11/2014

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