1700844552 NPI number — DEANNA R REINOSO MD

Table of content: DEANNA R REINOSO MD (NPI 1700844552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700844552 NPI number — DEANNA R REINOSO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REINOSO
Provider First Name:
DEANNA
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700844552
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 ESKENAZI AVE
Provider Second Line Business Mailing Address:
FIFTH THIRD BANK BLDG, 5TH FL
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46202-5166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-880-4121
Provider Business Mailing Address Fax Number:
317-880-4121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6940 MICHIGAN RD STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46268-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-266-2901
Provider Business Practice Location Address Fax Number:
317-266-2916
Provider Enumeration Date:
05/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  01053670A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200371030 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".