1770564734 NPI number — DR. MICHELLE W REED M.D.

Table of content: DR. MICHELLE W REED M.D. (NPI 1770564734)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770564734 NPI number — DR. MICHELLE W REED M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REED
Provider First Name:
MICHELLE
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770564734
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2055 NORMANDIE DR
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36111-2732
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-269-6337
Provider Business Mailing Address Fax Number:
334-834-0657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2055 NORMANDIE DR
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36111-2732
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-288-4624
Provider Business Practice Location Address Fax Number:
334-280-3628
Provider Enumeration Date:
11/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  15782 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: ME91309 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: MD 15782 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 108119 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106804 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106706 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 108244 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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