MEDICARE: DR. LEO A REYES 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	207Q00000X	Family Medicine Physician	036045343	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811992316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEO A REYES M.D.

Provider Business Mailing Address
First Line	:	1664 S. EASTWOOD DRIVE
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-4655
Country	:	US
Telephone Number	:	815-338-5940
Fax Number	:	815-206-5919

Provider Business Practice Location Address
First Line	:	1664 S. EASTWOOD DRIVE
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-4655
Country	:	US
Telephone Number	:	815-338-5940
Fax Number	:	815-338-5940

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	02/20/2012

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