Provider Demographics
NPI:1235113374
Name:REMER, STANLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:
Last Name:REMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 E 12 MILE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-2618
Mailing Address - Country:US
Mailing Address - Phone:248-336-0500
Mailing Address - Fax:248-336-2979
Practice Address - Street 1:28180 JOHN R RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-2850
Practice Address - Country:US
Practice Address - Phone:248-336-0500
Practice Address - Fax:248-336-2979
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006446208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI125593OtherCARE-PREFERRED CHOICES
MI700H217350OtherBLUE SHIELD
MIE26763OtherHAP
MIC3868OtherM'CARE
MI1235113374Medicaid
MIC3868OtherM'CARE
MI125593OtherCARE-PREFERRED CHOICES
MI1235113374Medicaid