Individual
REENA JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01046093A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0090000854
BCBS GROUP NUMBER
IL
05
—
200148810
—
IN
Enumeration date
08/18/2005
Last updated
05/16/2023
Update your record
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