Provider Demographics
NPI:1679826341
Name:REID, PATRICIA M (RDN, CDCES)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:REID
Suffix:
Gender:F
Credentials:RDN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39450 W 12 MILE ROAD
Mailing Address - Street 2:3RD FLOOR DIABETES CARE CONNECTIONS
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377
Mailing Address - Country:US
Mailing Address - Phone:313-574-2152
Mailing Address - Fax:313-874-9515
Practice Address - Street 1:39450 W 12 MILE ROAD
Practice Address - Street 2:DIABETES CARE CONNECTIONS 3RD FLOOR
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377
Practice Address - Country:US
Practice Address - Phone:313-574-2152
Practice Address - Fax:313-874-9515
Is Sole Proprietor?:No
Enumeration Date:2012-10-18
Last Update Date:2023-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1052645133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered