Healthcare Provider Details

I. General information

NPI: 1922305929
Provider Name (Legal Business Name): CHARLES HOWARD REISDORF NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 E GRAND RIVER AVE STE 112
HOWELL MI
48843-6585
US

IV. Provider business mailing address

3075 E GRAND RIVER AVE STE 112
HOWELL MI
48843-6585
US

V. Phone/Fax

Practice location:
  • Phone: 517-798-6766
  • Fax:
Mailing address:
  • Phone: 517-798-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704278150
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number21310526
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704278150
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: