Individual
TODD P REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1686 EISENHOWER RD, DE PERE, WI 54115-8145
(920) 496-4700
(920) 496-4705
Mailing address
PO BOX 19070, GREEN BAY, WI 54307-9070
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
37840
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32241700
—
WI
Enumeration date
07/17/2006
Last updated
09/19/2016
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