Provider Demographics
NPI:1942209978
Name:REAMES, DAVID R (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:REAMES
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 1:3175 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9434
Mailing Address - Country:US
Mailing Address - Phone:734-856-5494
Mailing Address - Fax:734-856-7184
Practice Address - Street 1:3175 SMITH RD
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9434
Practice Address - Country:US
Practice Address - Phone:734-856-5494
Practice Address - Fax:734-856-7184
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301047713207Q00000X
OH35050806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI000000147097OtherANTHEM
OH0590196Medicaid
MI00792OtherPARAMOUNT
MI080E810120OtherBCBS MI
MI01-03227OtherUHC
MI3315943Medicaid
MI080106178OtherRRMC
MI4002548OtherAETNA
MIM35150002Medicare ID - Type Unspecified
MI01-03227OtherUHC
MI3315943Medicaid