Healthcare Provider Details

I. General information

NPI: 1285538181
Provider Name (Legal Business Name): JAMES C. REYNOLDS II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26403 TROWBRIDGE ST
INKSTER MI
48141-3700
US

IV. Provider business mailing address

26403 TROWBRIDGE ST
INKSTER MI
48141-3700
US

V. Phone/Fax

Practice location:
  • Phone: 313-210-9144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number4703104974
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: