Provider Demographics
NPI:1609950500
Name:REIDY, MICHAEL F (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:F
Last Name:REIDY
Suffix:
Gender:M
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:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86002-0967
Mailing Address - Country:US
Mailing Address - Phone:928-773-0003
Mailing Address - Fax:928-773-1170
Practice Address - Street 1:1215 N BEAVER ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3120
Practice Address - Country:US
Practice Address - Phone:928-773-2200
Practice Address - Fax:928-773-2300
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMEDPHYSCOMLIC112031207RC0200X
NV19443207RC0200X, 207RP1001X
AZ36111207RC0200X, 207RP1001X
IDM-11933207RC0200X
ORMD165581207RC0200X
NC36811207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ158034Medicaid
NC2011718Medicare ID - Type Unspecified
NC89133H4Medicare ID - Type Unspecified
H78767Medicare UPIN
AZ158034Medicaid