Provider Demographics
NPI:1689684474
Name:REINA, JUAN C (MD)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:C
Last Name:REINA
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 1:200 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-5200
Mailing Address - Country:US
Mailing Address - Phone:513-424-1440
Mailing Address - Fax:513-424-1422
Practice Address - Street 1:200 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 160
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-5200
Practice Address - Country:US
Practice Address - Phone:513-424-1440
Practice Address - Fax:513-424-1422
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35084695207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2544036Medicaid
OH1063482OtherWORKERS COMP NUMBER
OHI22031Medicare UPIN
OHRE4147941Medicare PIN