Provider Demographics
NPI:1013081959
Name:REYNES, CARLOS MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:MANUEL
Last Name:REYNES
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 1:7756 MADISON ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-2058
Mailing Address - Country:US
Mailing Address - Phone:708-771-3471
Mailing Address - Fax:708-771-2553
Practice Address - Street 1:7756 MADISON ST
Practice Address - Street 2:SUITE 8
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-2058
Practice Address - Country:US
Practice Address - Phone:708-771-3471
Practice Address - Fax:708-771-2553
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK49124Medicare PIN
ILE85258Medicare UPIN