Provider Demographics
NPI:1104822691
Name:REID, HELENA A (DPM)
Entity type:Individual
Prefix:DR
First Name:HELENA
Middle Name:A
Last Name:REID
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 35TH AVENUE PL
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-8026
Mailing Address - Country:US
Mailing Address - Phone:309-762-5200
Mailing Address - Fax:309-762-5636
Practice Address - Street 1:840 35TH AVENUE PL
Practice Address - Street 2:SUITE 102
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-8026
Practice Address - Country:US
Practice Address - Phone:309-762-5200
Practice Address - Fax:309-762-5636
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004885213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532384OtherBLUE CROSS BLUE SHIELD IL
IL42117624432OtherUNITED HEALTHCARE RV
IL480025984OtherMEDICARE RAIL ROAD PROVID
ILK29441OtherMC INDIVIDUAL PROVIDER #
IL139503800OtherDEPT OF LABOR
IA96291OtherWELLMARK BCBS PROVIDER #
IL480025984OtherMEDICARE RAIL ROAD PROVID
IL213908Medicare PIN
ILK29441OtherMC INDIVIDUAL PROVIDER #