Healthcare Provider Details

I. General information

NPI: 1134858780
Provider Name (Legal Business Name): EMILY AUTUMN REITZEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date: 03/18/2024
Reactivation Date: 03/25/2024

III. Provider practice location address

1400 MEDICAL CAMPUS DR
TRAVERSE CITY MI
49684-7823
US

IV. Provider business mailing address

1400 MEDICAL CAMPUS DR
TRAVERSE CITY MI
49684-7823
US

V. Phone/Fax

Practice location:
  • Phone: 231-935-8000
  • Fax: 231-935-8099
Mailing address:
  • Phone: 231-935-8000
  • Fax: 231-935-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: