MEDICARE: DR. REGINA T NOACK M.D.

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	4301071403	MI
2	207P00000X	Emergency Medicine Physician	4301071403	MI

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	RN071403	OTHER	MI	BC/BS OF MI

General Provider Information

NPI Number	:	1447219670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REGINA T NOACK M.D.

Provider Business Mailing Address
First Line	:	4201 SAINT ANTOINE ST STE 3R
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48201-2153
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6071 W OUTER DR
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-2624
Country	:	US
Telephone Number	:	313-966-3300
Fax Number	:

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

Provider Enumeration Date	:	03/17/2006
Last Update Date	:	06/17/2010

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