Provider Demographics
NPI:1811982887
Name:REICHLEY, TINA BRUNS (MD)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:BRUNS
Last Name:REICHLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-966-5949
Mailing Address - Fax:765-962-6268
Practice Address - Street 1:535 W EATON PIKE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-2641
Practice Address - Country:US
Practice Address - Phone:765-935-8862
Practice Address - Fax:765-935-8863
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045173A207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200072830Medicaid
IN000000603328OtherANTHEM
IN259370AMedicare PIN
IN200072830Medicaid
IN259370AMedicare PIN
IN000000603328OtherANTHEM