Provider Demographics
NPI:1740628403
Name:REYNOLDS, JOSEPH MICHAEL (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
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 1:901 S KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66612-1210
Mailing Address - Country:US
Mailing Address - Phone:785-783-4080
Mailing Address - Fax:833-673-0416
Practice Address - Street 1:14700 W SAINT TERESA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-9601
Practice Address - Country:US
Practice Address - Phone:316-274-0142
Practice Address - Fax:316-719-1033
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-43611207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0121053Medicaid
OH0121053Medicaid
OHH512738Medicare PIN