Individual
REENA JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2150 GETTLER ST STE 255, DYER, IN 46311-2381
(219) 864-2235
(219) 365-1398
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
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
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