Provider Demographics
NPI:1386684843
Name:REYES, MILAGROS PAGADUAN (MD)
Entity Type:Individual
Prefix:
First Name:MILAGROS
Middle Name:PAGADUAN
Last Name:REYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 E MAPLE RD
Mailing Address - Street 2:SUITE 400-CREDENTIALING
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1138
Mailing Address - Country:US
Mailing Address - Phone:313-745-7105
Mailing Address - Fax:313-993-0302
Practice Address - Street 1:3990 JOHN R 5 HUDSON
Practice Address - Street 2:HARPER HOSPITAL
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2018
Practice Address - Country:US
Practice Address - Phone:313-745-7105
Practice Address - Fax:313-993-0302
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031275207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
440Q263940OtherBLUE CROSS-BLUE CROSS
MR031275OtherCOMMERCIAL-COMMERCIAL NUMBER
MR031275OtherCHAMPUS-CHAMPUS
B48251Medicare UPIN
440Q263940OtherBLUE CROSS-BLUE CROSS
MR031275OtherCOMMERCIAL-COMMERCIAL NUMBER