Provider Demographics
NPI:1306871173
Name:JAMES, REESE (DO)
Entity type:Individual
Prefix:
First Name:REESE
Middle Name:
Last Name:JAMES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32627
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48232-0627
Mailing Address - Country:US
Mailing Address - Phone:866-744-1452
Mailing Address - Fax:586-412-4101
Practice Address - Street 1:1375 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1350
Practice Address - Country:US
Practice Address - Phone:810-667-5744
Practice Address - Fax:810-667-5741
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010115842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2839106Medicaid
MI300063538OtherRRMC
MI2839124Medicaid
MI3056329475OtherBCBS INDIVIDUAL #
MICA3518OtherMEDICARE RR GROUP PIN
MI310D460020OtherBCBS GROUP PIN
MI0D46002011Medicare ID - Type UnspecifiedINDIVIDUAL #
MI2839106Medicaid
MI2839124Medicaid
MI300063538OtherRRMC
C52052Medicare UPIN