Provider Demographics
NPI:1407083595
Name:RESCHKE, MIKA ALICIA-BROOKS (MD)
Entity Type:Individual
Prefix:
First Name:MIKA
Middle Name:ALICIA-BROOKS
Last Name:RESCHKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIKA
Other - Middle Name:ALICIA-BROOKS
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:601 JOHN ST STE M-515
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5352
Mailing Address - Country:US
Mailing Address - Phone:269-341-7145
Mailing Address - Fax:269-341-7148
Practice Address - Street 1:601 JOHN ST STE M-515
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5352
Practice Address - Country:US
Practice Address - Phone:614-293-8704
Practice Address - Fax:614-293-4063
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4301111572208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program