Provider Demographics
NPI:1902541188
Name:REID, MICHAEL ROJE
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROJE
Last Name:REID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 W GRACE ST
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4712
Mailing Address - Country:US
Mailing Address - Phone:352-344-6969
Mailing Address - Fax:
Practice Address - Street 1:402 W GRACE ST
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4712
Practice Address - Country:US
Practice Address - Phone:352-344-6969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program