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General NPI Number Information
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NPI Number | 1255324976
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Entity Type | Individual
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Provider Name | BRIDGET E REIDY M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/28/2005
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Last Update Date | 04/06/2011
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Provider Practice Location Address
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Address Line | 2550 MEADOWBROOK ROAD
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City | BENTON HARBOR
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State | MI
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Zip | 49022-9069
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Country | US
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Telephone | 269-985-4441
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Fax | 269-985-4494
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Provider Business Mailing Address
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Address Line | P.O. BOX 458
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City | NILES
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State | MI
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Zip | 49120-0458
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Country | US
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Telephone | 269-471-7741
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Fax | 269-471-1581
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 407192
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 4301407192
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License Number State | MI
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