Healthcare Provider Details

I. General information

NPI: 1528557089
Provider Name (Legal Business Name): MAIA REILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11108 PARKVIEW CIRCLE DR STE 5100
FORT WAYNE IN
46845-1730
US

IV. Provider business mailing address

16001 W 9 MILE RD
SOUTHFIELD MI
48075-4818
US

V. Phone/Fax

Practice location:
  • Phone: 260-266-2800
  • Fax: 260-266-2805
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01100397A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: