Individual
MICHAEL GEORGE REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1602 W 15TH AVE, STE B, EMPORIA, KS 66801-5672
(620) 342-6989
(620) 342-2262
Mailing address
1602 W 15TH AVE, STE B, EMPORIA, KS 66801-5672
(620) 342-6989
(620) 342-2262
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
04-24388
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100164440A
—
KS
01
—
47-1424576
TAX ID
—
01
—
48-0792406
OLD TAX ID
—
Enumeration date
06/09/2005
Last updated
08/11/2014
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