Provider Demographics
NPI:1053324673
Name:BREMER PROSTHETIC DESIGN, INC.
Entity Type:Organization
Organization Name:BREMER PROSTHETIC DESIGN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAPA
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:810-733-3375
Mailing Address - Street 1:G3487 S. LINDEN RD. STE. U
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-3020
Mailing Address - Country:US
Mailing Address - Phone:810-733-3375
Mailing Address - Fax:810-733-0117
Practice Address - Street 1:G3487 S. LINDEN RD. STE. U
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-3020
Practice Address - Country:US
Practice Address - Phone:810-733-3375
Practice Address - Fax:810-733-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2973794Medicaid
MI2973794Medicaid