Provider Demographics
NPI:1538109566
Name:REYES, MICHELE (DO)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:REYES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6799 N GREEN BAY AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-3422
Mailing Address - Country:US
Mailing Address - Phone:262-241-9131
Mailing Address - Fax:414-446-8627
Practice Address - Street 1:6799 N GREEN BAY AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53209-3422
Practice Address - Country:US
Practice Address - Phone:262-241-9131
Practice Address - Fax:414-446-8627
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2014-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIF93950Medicare UPIN