Provider Demographics
NPI:1053714881
Name:TULLOCH-REID, MIKAEL DAWIT (MBBS)
Entity type:Individual
Prefix:DR
First Name:MIKAEL
Middle Name:DAWIT
Last Name:TULLOCH-REID
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HEART INSTITUTE OF THE CARIBBEAN,
Mailing Address - Street 2:23 BALMORAL AVENUE
Mailing Address - City:KINGSTON
Mailing Address - State:KINGSTON
Mailing Address - Zip Code:KINGSTON 10
Mailing Address - Country:JM
Mailing Address - Phone:876-906-2105
Mailing Address - Fax:
Practice Address - Street 1:HEART INSTITUTE OF THE CARIBBEAN,
Practice Address - Street 2:23 BALMORAL AVENUE
Practice Address - City:KINGSTON
Practice Address - State:KINGSTON
Practice Address - Zip Code:KINGSTON 10
Practice Address - Country:JM
Practice Address - Phone:876-906-2105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-07
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070596L207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD070596LOtherMEDICAL LICENSE