Provider Demographics
NPI:1649472879
Name:REYNOLDS, KILEY JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:KILEY
Middle Name:JOSEPH
Last Name:REYNOLDS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 SW 117TH AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3856
Mailing Address - Country:US
Mailing Address - Phone:305-595-7246
Mailing Address - Fax:305-595-7242
Practice Address - Street 1:8200 SW 117TH AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3856
Practice Address - Country:US
Practice Address - Phone:305-595-7246
Practice Address - Fax:305-595-7242
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10004207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA7835293OtherCIGNA
GA159466033Medicaid
GA7835293OtherCIGNA