Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 4301053833 | MI |
N | 207VX0201X | Gynecologic Oncologist | 4301053833 | MI |
NPI | 1528155397 |
---|---|
Provider Name | R Kevin Reynolds |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-5902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 29/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1988863 | (05) | MI |
E50142 | (02) | MI |