Provider Demographics
NPI:1306914890
Name:REED, KERRIE (MD)
Entity type:Individual
Prefix:
First Name:KERRIE
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26W171 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-6078
Mailing Address - Country:US
Mailing Address - Phone:630-909-7000
Mailing Address - Fax:630-909-7001
Practice Address - Street 1:610 S MAPLE AVE
Practice Address - Street 2:SUITE 3420
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-1091
Practice Address - Country:US
Practice Address - Phone:708-934-7100
Practice Address - Fax:708-934-7106
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102526225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102526Medicaid
IL363236791OtherTAX ID #
ILL87435Medicare ID - Type Unspecified
ILL87434Medicare ID - Type Unspecified
IL036102526Medicaid