Reynolds, Susan Kim

Reynolds, Susan Kim is an individual health care provider with primary practice located at 1215 Vandalia St , Collinsville IL 62234-4060. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Family Medicine is her primary health care specialty. Reynolds, Susan Kim can be contacted via phone (618) 343-6015.

Contact Information

Primary practice address
1215 Vandalia St Collinsville IL 62234-4060
Phone: (618) 343-6015
Fax: (618) 578-5759
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 036126550 Illinois
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X R5E07 Missouri
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 036-126550 Illinois
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X R5E07 Missouri

Profile Details

NPI number 1700877032
LBN Legal business name Reynolds, Susan Kim
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 4th, 2005
Last updated May 24th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1700877032 NPPES
Missouri MEDICAID 1700877032

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