Basic Information
| Provider Information | |||||||||
| NPI: | 1144208356 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | REEVES | ||||||||
| FirstName: | MONIQUE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 TOWNER ST | ||||||||
| Address2: | P.O BOX 0915 | ||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481985752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345446869 | ||||||||
| FaxNumber: | 7345446704 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 TOWNER ST | ||||||||
| Address2: | |||||||||
| City: | YPSILANTI | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481985752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7345446869 | ||||||||
| FaxNumber: | 7345446704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2006 | ||||||||
| LastUpdateDate: | 08/04/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | 430107057 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 2083P0901X | 4301070357 | MI | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine |
ID Information
| ID | Type | State | Issuer | Description | 10-4552100 | 05 | MI | MEDICAID | 10-4552147 | 05 | MI | MEDICAID | 10-4552165 | 05 | MI | MEDICAID | 75255183 | 05 | MI | MEDICAID | 10-4552183 | 05 | MI | MEDICAID | 10-4552138 | 05 | MI | MEDICAID | 10-4552174 | 05 | MI | MEDICAID | 0108234972 | 01 | MI | BCBS | OTHER | 10-4942124 | 05 | MI | MEDICAID | 10-4552129 | 05 | MI | MEDICAID | 10-4552156 | 05 | MI | MEDICAID |