Provider Demographics
NPI:1043046691
Name:REEVES, MATTHEW W (NP)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:W
Last Name:REEVES
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:421 W SUNNYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-2533
Mailing Address - Country:US
Mailing Address - Phone:843-636-2662
Mailing Address - Fax:
Practice Address - Street 1:17320 W 12 MILE RD STE 101
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2102
Practice Address - Country:US
Practice Address - Phone:248-727-3456
Practice Address - Fax:248-557-4697
Is Sole Proprietor?:No
Enumeration Date:2024-09-10
Last Update Date:2025-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704371275363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine