Healthcare Provider Details

I. General information

NPI: 1801215876
Provider Name (Legal Business Name): LINDSAY FUCHS REILLY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE
SAN JOSE CA
95128-2604
US

IV. Provider business mailing address

4201 SAINT ANTOINE ST SUITE 6C
DETROIT MI
48201-2153
US

V. Phone/Fax

Practice location:
  • Phone: 313-577-5009
  • Fax: 313-577-5310
Mailing address:
  • Phone: 313-577-5009
  • Fax: 313-577-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA162915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: