Provider Demographics
NPI:1720043094
Name:REEVES, THOMAS F (PA-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:F
Last Name:REEVES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 B DR N
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-8420
Mailing Address - Country:US
Mailing Address - Phone:517-629-2134
Mailing Address - Fax:517-629-7953
Practice Address - Street 1:300 B DR N
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-8420
Practice Address - Country:US
Practice Address - Phone:517-629-2134
Practice Address - Fax:517-629-7953
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601003090363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ04523Medicare UPIN
MIA37669063Medicare PIN
MIN82970001Medicare PIN