Healthcare Provider Details

I. General information

NPI: 1841834074
Provider Name (Legal Business Name): KATRINA REID MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE STE 245
LANSING MI
48912-1897
US

IV. Provider business mailing address

2530 MARFITT RD
EAST LANSING MI
48823-6343
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5710
  • Fax:
Mailing address:
  • Phone: 517-318-0542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4351056081
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: