Individual
MARY ALICE M REID
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1627 E BRISTOL ST, ELKHART, IN 46514-3817
(574) 262-0313
(574) 262-8163
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01044674
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200076800
—
IN
Enumeration date
10/31/2005
Last updated
08/12/2025
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