Individual
MARLETA REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
225 E CHICAGO AVE, CHICAGO, IL 60611
(800) 543-7362
Mailing address
225 E CHICAGO AVE # 118, CHICAGO, IL 60611-2991
(312) 227-4210
(312) 227-9637
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
036062051
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036062051
—
IL
Enumeration date
09/20/2005
Last updated
05/10/2019
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