Individual
KIREN JEAN KRESA-REAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
9427 SW BARNES RD, STE 595, PORTLAND, OR 97225-6640
(503) 216-1060
(503) 216-1066
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
18694
WV
2084N0400X
Neurology Physician
Primary
MD152526
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001710644
BCBS SERVICE ID BOX 33
WV
01
—
001721997
BCBS BOX 24
WV
05
—
0090571000
—
WV
01
—
1039965
WORKERS COMP
WV
01
—
5080656
AETNA
WV
01
—
550751874
CARELINK
WV
Enumeration date
09/27/2006
Last updated
10/27/2010
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