Provider Demographics
NPI:1750374245
Name:OWEN, REID M (MD)
Entity type:Individual
Prefix:MR
First Name:REID
Middle Name:M
Last Name:OWEN
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 1:154 LEONARD WOOD S APT 113
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5953
Mailing Address - Country:US
Mailing Address - Phone:847-997-5867
Mailing Address - Fax:847-681-1366
Practice Address - Street 1:154 LEONARD WOOD S APT 113
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-5953
Practice Address - Country:US
Practice Address - Phone:847-997-5867
Practice Address - Fax:847-681-1366
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036046268208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21608935OtherBCBS PROVIDER NUMBER
IL036046268Medicaid
IL791021783OtherRR MEDICARE NUMBER
IL642340Medicare ID - Type UnspecifiedMEDICARE PART B NUMBER
ILD14236Medicare UPIN