Provider Demographics
NPI:1063410132
Name:REILLY, KEVIN EUGENE (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:EUGENE
Last Name:REILLY
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 1:4701 CREEK ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242
Mailing Address - Country:US
Mailing Address - Phone:513-618-9011
Mailing Address - Fax:513-588-2479
Practice Address - Street 1:6909 GOOD SAMARITAN DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-5207
Practice Address - Country:US
Practice Address - Phone:513-245-2500
Practice Address - Fax:513-245-5424
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35068341207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4026563002OtherCIGNA
OH004463OtherANTHEM
OH0920516OtherUNITED HEALTHCARE
OH0154569Medicaid
OH200026469OtherMEDICARE RAILROAD
OH0225920002Medicare NSC
OHRE0791011Medicare PIN
OH004463OtherANTHEM
OH0920516OtherUNITED HEALTHCARE