Provider Demographics
NPI:1497833487
Name:REEDY, RICHARD L (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:L
Last Name:REEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3631 N MORRISON ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304
Mailing Address - Country:US
Mailing Address - Phone:765-281-3443
Mailing Address - Fax:765-286-4124
Practice Address - Street 1:3631 N MORRISON ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304
Practice Address - Country:US
Practice Address - Phone:765-281-3443
Practice Address - Fax:765-286-4124
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01022314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100387120Medicaid
IN100387120Medicaid
P00227634Medicare PIN
IN228050BMedicare PIN
INE41089Medicare UPIN