Provider Demographics
NPI:1053381764
Name:REED, STEPHEN K (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:K
Last Name:REED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6920 POINTE INVERNESS WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7934
Mailing Address - Country:US
Mailing Address - Phone:260-479-3514
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7916 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4140
Practice Address - Country:US
Practice Address - Phone:260-432-2297
Practice Address - Fax:260-434-6433
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01036911A207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00783732OtherLMG RAILROAD
OH0972827Medicaid
IN000000087410OtherANTHEM
IN100363190Medicaid
INE47559Medicare UPIN
IN260690GGGMedicare PIN
110079756OtherRAILROAD
OH0972827Medicaid
INP00783732OtherRAILROAD
INE47559Medicare UPIN