Provider Demographics
NPI:1881629152
Name:REED, BRENNAN R (DPM)
Entity Type:Individual
Prefix:MR
First Name:BRENNAN
Middle Name:R
Last Name:REED
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301
Mailing Address - Country:US
Mailing Address - Phone:217-222-6381
Mailing Address - Fax:217-228-8726
Practice Address - Street 1:601 S 8TH ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301
Practice Address - Country:US
Practice Address - Phone:217-222-6381
Practice Address - Fax:217-228-8726
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004104213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60201280OtherBLUE CROSS BLUE SHIELD
IL016004104Medicaid
IL60201280OtherBLUE CROSS BLUE SHIELD
IL016004104Medicaid
IL0206900001Medicare NSC
IL480006889Medicare PIN