Provider Demographics
NPI:1033231923
Name:KREMER, PC
Entity Type:Organization
Organization Name:KREMER, PC
Other - Org Name:EDWIN F. KREMER, PHD, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KREMER-START
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-459-8971
Mailing Address - Street 1:750 FRONT AVE NW
Mailing Address - Street 2:SUITE 311
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4400
Mailing Address - Country:US
Mailing Address - Phone:616-459-8971
Mailing Address - Fax:616-459-2361
Practice Address - Street 1:750 FRONT AVE NW
Practice Address - Street 2:SUITE 311
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4400
Practice Address - Country:US
Practice Address - Phone:616-459-8971
Practice Address - Fax:616-459-2361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010706161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D14590OtherBLUE CROSS BLUE SHIELD
680004805OtherRAILROAD MEDICARE
MI716836000OtherMAGELLAN
MI0D14590OtherBLUE CROSS BLUE SHIELD