Provider Demographics
NPI:1477660710
Name:REID, KERN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KERN
Middle Name:A
Last Name:REID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KERN
Other - Middle Name:AUNDRE
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Doing Business As
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:414-219-2000
Mailing Address - Fax:414-671-8860
Practice Address - Street 1:1020 N 12TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233
Practice Address - Country:US
Practice Address - Phone:414-219-7136
Practice Address - Fax:414-219-6294
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30813207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31860300Medicaid
WI31860300Medicaid
738250009Medicare ID - Type UnspecifiedMEDICARE PROVIDER
F31145Medicare UPIN