Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QG0300X | Family Doctor - Geriatric Medicine | 407192 | MI |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 4301407192 | MI |
NPI | 1255324976 |
---|---|
Provider Name | Dr. Bridget E Reidy |
First Address | Niles, MI 49120-0458 |
Second Address | Benton Harbor, MI 49022-9069 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2005 |
Last Update Date | 06/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
080817663 | BCBS (01) | MI |
3103680 | (05) | OH |
4447105 | (05) | MI |
E68918 | (02) | |
P112580 | BCN (01) | MI |