Healthcare Provider Details

I. General information

NPI: 1518133891
Provider Name (Legal Business Name): PAMELA L REAVES MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20176 LIVERNOIS AVE SUITE 101
DETROIT MI
48221-1346
US

IV. Provider business mailing address

20176 LIVERNOIS AVE SUITE 101
DETROIT MI
48221-1346
US

V. Phone/Fax

Practice location:
  • Phone: 313-927-0000
  • Fax:
Mailing address:
  • Phone: 313-927-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberPR056648
License Number StateMI

VIII. Authorized Official

Name: MS. LABRETTA D QUICK
Title or Position: BILLING MANAGER
Credential:
Phone: 313-864-3000