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General NPI Number Information
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NPI Number | 1902866734
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Entity Type | Individual
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Provider Name | REGINALD J EADIE M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/24/2006
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Last Update Date | 02/18/2009
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Provider Practice Location Address
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Address Line | 6071 W OUTER DR
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City | DETROIT
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State | MI
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Zip | 48235-2624
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Country | US
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Telephone | 313-745-2780
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Fax | 313-745-1520
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Provider Business Mailing Address
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Address Line | 6940 KENNESAW RD
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City | CANTON
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State | MI
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Zip | 48187-1283
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Country | US
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Telephone |
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Fax |
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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 | 207PE0004X
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Taxonomy Name | Emergency Medical Services (Emergency Medicine) Physician
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License Number | 4301065909
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 4301065909
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License Number State | MI
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