MEDICARE: MS. LISA MARIE REED MHS, PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601004920	MI

General Provider Information

NPI Number	:	1952510588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA MARIE REED MHS, PAC

Provider Business Mailing Address
First Line	:	106 E. MAIN ST.
Second Line	:
City	:	SEBEWAING
State	:	MI
Zip	:	48759-1568
Country	:	US
Telephone Number	:	989-883-3800
Fax Number	:	989-883-9131

Provider Business Practice Location Address
First Line	:	4497 SHEFFIELD PLACE
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706
Country	:	US
Telephone Number	:	989-894-8400
Fax Number	:	989-883-9131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	11/03/2012

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