Basic Information
| Provider Information | |||||||||
| NPI: | 1306899877 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REODICA | ||||||||
| FirstName: | ALEX | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1649 | ||||||||
| Address2: | |||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443091649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305630618 | ||||||||
| FaxNumber: | 3305630604 | ||||||||
| Practice Location | |||||||||
| Address1: | 3730 TABS DR | ||||||||
| Address2: | |||||||||
| City: | UNIONTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446859562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3305630618 | ||||||||
| FaxNumber: | 3305630604 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 02/13/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35086386 | OH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2655934 | 05 | OH | MEDICAID |