Basic Information
| Provider Information | |||||||||
| NPI: | 1013083187 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GALEN | ||||||||
| FirstName: | RENEE | ||||||||
| MiddleName: | MICHELLE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3868 | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477373868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124269700 | ||||||||
| FaxNumber: | 8124269701 | ||||||||
| Practice Location | |||||||||
| Address1: | 4233 GATEWAY BLVD | ||||||||
| Address2: | |||||||||
| City: | NEWBURGH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476308900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124269700 | ||||||||
| FaxNumber: | 8124269701 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 01/03/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01054774A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200446020 | 05 | IN | MEDICAID | 000000290170 | 01 | IN | ANTHEM | OTHER | 64068240 | 01 | KY | KY MEDICAID | OTHER |