Provider Demographics
NPI:1053375295
Name:REID-RENNER, KAREN L (MD MPH)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:L
Last Name:REID-RENNER
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 E ATWATER AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-3707
Mailing Address - Country:US
Mailing Address - Phone:812-339-6744
Mailing Address - Fax:812-287-8223
Practice Address - Street 1:1403 E ATWATER AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-3707
Practice Address - Country:US
Practice Address - Phone:812-339-6744
Practice Address - Fax:812-287-8223
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055670A207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000217697OtherANTHEM PROVIDER NUMBER
IN200367600AMedicaid
IN6088398OtherCIGNA PROVIDER NUMBER
IN6088398OtherCIGNA PROVIDER NUMBER
IN200367600AMedicaid