Provider Demographics
NPI:1427092410
Name:REYE, ROBIN RUSSELL (SAPA-C)
Entity type:Individual
Prefix:MR
First Name:ROBIN
Middle Name:RUSSELL
Last Name:REYE
Suffix:
Gender:M
Credentials:SAPA-C
Other - Prefix:MR
Other - First Name:ROBIN
Other - Middle Name:RUSSELL
Other - Last Name:REYE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SAPA-C
Mailing Address - Street 1:4228 MOUNT MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIAVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48421-9373
Mailing Address - Country:US
Mailing Address - Phone:810-793-2241
Mailing Address - Fax:810-793-2587
Practice Address - Street 1:4228 MT. MORRIS RD
Practice Address - Street 2:
Practice Address - City:COLUMBIAVILLE
Practice Address - State:MI
Practice Address - Zip Code:48421
Practice Address - Country:US
Practice Address - Phone:810-793-2241
Practice Address - Fax:810-793-2587
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001893363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIRR001893OtherBCBS
MIM92460023Medicare PIN