Provider Demographics
NPI:1003378928
Name:REID, AIDAN JAMES (DO)
Entity Type:Individual
Prefix:
First Name:AIDAN
Middle Name:JAMES
Last Name:REID
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:AIDAN
Other - Middle Name:JAMES
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-6800
Mailing Address - Fax:414-337-7068
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-6800
Practice Address - Fax:414-337-7068
Is Sole Proprietor?:No
Enumeration Date:2019-04-01
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI75542-21208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1003378928Medicaid