Individual
MICHAEL REARDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3601 W. 13 MILE RD, 400 FSC-PCS, ROYAL OAK, MI 48073-6769
(248) 423-2481
Mailing address
3601 W. 13 MILE RD, 400 FSC-PCS, ROYAL OAK, MI 48073-6769
(248) 423-2481
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704200718
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4167550
—
MI
01
—
430F364420
BCBSM
MI
Enumeration date
03/02/2006
Last updated
05/27/2008
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