Individual
DR. KIM MARIE REILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2021-01611
NC
208000000X
Pediatrics Physician
35078399R
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000177532
UNISON PIN
OH
01
—
000000185154
ANTHEM PIN
OH
01
—
0989499
GROUP MEDICAID
OH
01
—
1204464
UHC PIN
OH
05
—
2189911
—
OH
01
—
311413469053
CARESOURCE PIN
OH
01
—
RE4028581
MEDICARE PTAN
—
Enumeration date
12/14/2005
Last updated
01/13/2023
Update your record
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