Provider Demographics
NPI:1952359093
Name:REEVES, MICHAEL LEO (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LEO
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:PO BOX 80458
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37414-7458
Mailing Address - Country:US
Mailing Address - Phone:423-495-7580
Mailing Address - Fax:423-495-7589
Practice Address - Street 1:725 GLENWOOD DR
Practice Address - Street 2:SUITE E688
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1163
Practice Address - Country:US
Practice Address - Phone:423-648-1148
Practice Address - Fax:423-643-2217
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000019635174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN010025756OtherRAIL ROAD MEDICARE
TN0089721OtherBLUE CROSS/BLUE SHIELD
TNTN0101OtherJOHN DEERE
TN621387786OtherPRIVATE PAYER
TNTN0101OtherJOHN DEERE
TN621387786OtherPRIVATE PAYER
TN3043527Medicare ID - Type Unspecified