Individual
ANDREW REYNOLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
7930 N SHADELAND AVE, INDIANAPOLIS, IN 46250-2041
(317) 621-6275
(317) 621-4545
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300005207
—
IN
01
—
P01424398
RR MEDICARE
IN
Enumeration date
09/24/2014
Last updated
11/27/2023
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