Provider Demographics
NPI:1689360505
Name:REEVES, SHANE AUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:AUSTIN
Last Name:REEVES
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 1:3901 BEAUBIEN BLVD
Mailing Address - Street 2:PEDIATRIC EDUCATION DEPARTMENT-ROOM 3T-72
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:313-745-5533
Mailing Address - Fax:
Practice Address - Street 1:3901 BEAUBIEN BLVD
Practice Address - Street 2:PEDIATRIC EDUCATION DEPARTMENT-ROOM 3T-72
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program