Provider Demographics
NPI:1275938805
Name:EDWIN F. KREMER, PH.D. PC
Entity Type:Organization
Organization Name:EDWIN F. KREMER, PH.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:REIDZANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-459-8971
Mailing Address - Street 1:750 FRONT STREET NW
Mailing Address - Street 2:SUITE 311
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504
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:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089574251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health