MEDICARE: PAMELA L REAVES MD PC

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	207VG0400X	Gynecology Physician	PR056648	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

General Provider Information

NPI Number	:	1518133891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAMELA L REAVES MD PC

Provider Business Mailing Address
First Line	:	20176 LIVERNOIS AVE
Second Line	:	SUITE 101
City	:	DETROIT
State	:	MI
Zip	:	48221-1346
Country	:	US
Telephone Number	:	313-927-0000
Fax Number	:

Provider Business Practice Location Address
First Line	:	20176 LIVERNOIS AVE
Second Line	:	SUITE 101
City	:	DETROIT
State	:	MI
Zip	:	48221-1346
Country	:	US
Telephone Number	:	313-927-0000
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MS. LABRETTA D QUICK
Credential	:
Telephone Number	:	313-864-3000

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	05/06/2008

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