Individual
KENNETH W REED
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
9660 WICKER AVE, ST JOHN, IN 46373-9487
(219) 365-1166
(219) 365-8852
Mailing address
9660 WICKER AVE, ST JOHN, IN 46373-9487
(219) 365-1166
(219) 365-8852
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02002051A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000203724
ANTHEM BCBS
IN
01
—
0091143293
BCBS OF ILLINOIS
IL
01
—
080178952
MEDICARE RAILROAD
IN
05
—
200341680
—
IN
Enumeration date
07/20/2005
Last updated
05/14/2010
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