MEDICARE: LYDIA REASONOVER BEST MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	4301076458	MI
2	207Q00000X	Family Medicine Physician	Q2103	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0H208910	OTHER	MI	BCBSM GROUP PIN
3	700E031600	OTHER	MI	BCBSM GROUP PIN

General Provider Information

NPI Number	:	1063522167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA REASONOVER BEST MD

Provider Business Mailing Address
First Line	:	PO BOX 844658
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-4658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 SPRING AVE STE 130
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75210-1350
Country	:	US
Telephone Number	:	214-835-3060
Fax Number	:	214-865-3070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/05/2021

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