Provider Demographics
NPI:1518133891
Name:PAMELA L REAVES MD PC
Entity Type:Organization
Organization Name:PAMELA L REAVES MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LABRETTA
Authorized Official - Middle Name:D
Authorized Official - Last Name:QUICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-864-3000
Mailing Address - Street 1:20176 LIVERNOIS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-1346
Mailing Address - Country:US
Mailing Address - Phone:313-927-0000
Mailing Address - Fax:
Practice Address - Street 1:20176 LIVERNOIS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-1346
Practice Address - Country:US
Practice Address - Phone:313-927-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPR056648207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104438026Medicaid
MI104438026Medicaid
MIP25050FMedicare UPIN