Provider Demographics
NPI:1477787620
Name:REIS, MEGAN KATHLEEN (DO)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:KATHLEEN
Last Name:REIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8733 WILLOW BLVD
Mailing Address - Street 2:UNIT 4E
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1661
Mailing Address - Country:US
Mailing Address - Phone:630-479-8476
Mailing Address - Fax:
Practice Address - Street 1:10750 W 143RD ST
Practice Address - Street 2:STE. 50
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-1924
Practice Address - Country:US
Practice Address - Phone:708-364-1600
Practice Address - Fax:708-364-1695
Is Sole Proprietor?:No
Enumeration Date:2009-05-02
Last Update Date:2009-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.122604208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics