Individual
DR. REGINALD J EADIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6071 W OUTER DR, DETROIT, MI 48235-2624
(313) 745-2780
(313) 745-1520
Mailing address
6940 KENNESAW RD, CANTON, MI 48187-1283
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
4301065909
MI
208D00000X
General Practice Physician
4301065909
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104184200
—
MI
05
—
104205660
—
MI
01
—
RE065909
BC/BS OF MI
MI
Enumeration date
03/24/2006
Last updated
02/18/2009
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