Provider Demographics
NPI:1497740237
Name:REYES, BENEDICTO L (MD)
Entity Type:Individual
Prefix:
First Name:BENEDICTO
Middle Name:L
Last Name:REYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9998 CROSSPOINT BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3307
Mailing Address - Country:US
Mailing Address - Phone:317-579-2150
Mailing Address - Fax:317-579-2130
Practice Address - Street 1:9998 CROSSPOINT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3307
Practice Address - Country:US
Practice Address - Phone:317-579-2150
Practice Address - Fax:317-579-2130
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10432162085R0202X
IN01043216A2085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN822400WOtherMEDICARE PTAN
P00018311OtherRR MEDICARE PIN
P00018401OtherRR MEDICARE PIN
P00024405OtherRR MEDICARE PIN
IN000000109943OtherANTHEM
IN300109485OtherRAILROAD MEDICARE
P00018314OtherRR MEDICARE PIN
P00018580OtherRR MEDICARE PIN
IN200142070AMedicaid
P00018312OtherRR MEDICARE PIN
P00023111OtherRR MEDICARE PIN
P00018308OtherRR MEDICARE PIN
P00018313OtherRR MEDICARE PIN
P00021420OtherRR MEDICARE PIN
P00018395OtherRR MEDICARE PIN
P00018588OtherRR MEDICARE PIN
P00018401OtherRR MEDICARE PIN
P00018314OtherRR MEDICARE PIN
IN822400WMedicare PIN
151700OOMedicare PIN
151560CCMedicare PIN