| Doctor Name: | DR. REGINALD J EADIE |
| NPI Number: | 1902866734 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 4301065909 |
| Business Practice Address: | 6071 W Outer Dr Detroit, MI - 482352624 |
| Business Phone Number: | 3137452780 |
| Business Fax Number: | 3137451520 |
| Mailing Address: | 6940 Kennesaw Rd, CANTON |
| State: | MI |
| Postal Code: | 481871283 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 03/24/2006 |
| NPI Last Update Date: | 02/18/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 4301065909 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |