Individual
MATTHEW RUSSELL REED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
714 N MICHIGAN ST, SOUTH BEND, IN 46601-1035
(574) 647-7477
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01073839A
IN
207Q00000X
Family Medicine Physician
11016056A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000879692
BCBS BMG E BLAIR WARNER
IN
05
—
201112710
—
IN
01
—
P01373879
RR MEDICARE
IN
Enumeration date
06/22/2011
Last updated
04/05/2021
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