Basic Information
| Provider Information | |||||||||
| NPI: | 1306947486 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REID | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 813 ROYAL AVE | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480733272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485495053 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 27301 DEQUINDRE RD | ||||||||
| Address2: | SUITE 314 | ||||||||
| City: | MADISON HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480713473 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2483994400 | ||||||||
| FaxNumber: | 2483994840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 03/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301080013 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 38-2877787 | 01 | MI | FEDERAL TAX ID | OTHER | 700H217350 | 01 | MI | BLUE SHIELD GROUP | OTHER |