1306947486 NPI number — DR. ROBERT E REID II M.D.

Table of content: DR. ROBERT E REID II M.D. (NPI 1306947486)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306947486 NPI number — DR. ROBERT E REID II M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REID
Provider First Name:
ROBERT
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
II
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1306947486
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
813 ROYAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROYAL OAK
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48073-3272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-549-5053
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27301 DEQUINDRE RD
Provider Second Line Business Practice Location Address:
SUITE 314
Provider Business Practice Location Address City Name:
MADISON HEIGHTS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48071-3473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-399-4400
Provider Business Practice Location Address Fax Number:
248-399-4840
Provider Enumeration Date:
09/25/2006

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: 207R00000X , with the licence number:  4301080013 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 38-2877787 . This is a "FEDERAL TAX ID" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 700H217350 . This is a "BLUE SHIELD GROUP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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