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Individual

CARLY KATHLEEN REISING

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
7500 CHALLIS RD FL 1, BRIGHTON, MI 48116-9416
(810) 263-4000
Mailing address
3621 S STATE ST, ANN ARBOR, MI 48108-1633
(734) 647-5299

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085004054
IL
363A00000X
Physician Assistant
Primary
5601007564
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1164705430
MI
Enumeration date
09/23/2011
Last updated
06/15/2023
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