Provider Demographics
NPI:1417945288
Name:GRIEMSMAN, STACIE L (MD)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:L
Last Name:GRIEMSMAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MAIL CODE 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:616-391-4600
Mailing Address - Fax:616-486-0133
Practice Address - Street 1:2249 WEALTHY ST SE
Practice Address - Street 2:SUITE 110
Practice Address - City:EAST GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-3052
Practice Address - Country:US
Practice Address - Phone:616-391-4600
Practice Address - Fax:616-486-0133
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2021-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301084107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
102604OtherAETNA
381908328OtherFIRST HEALTH
381908328OtherPPOM
MI4628058Medicaid
0998654OtherHEALTH PLUS OF MICHIGAN
146040OtherGREAT LAKES HEALTH PLAN
080G310060OtherBCBS OF MICHIGAN
1012013OtherHEALTH ADVANTAGE PPO
1012013OtherMCLAREN HEALTH PLAN
P33294FOtherBLUE CARE NETWORK OF MI
244OtherCOMMUNITY CARE OF MI
4628058OtherMOLINA HEALTH CARE OF MI
HCAPOther381908328
146040OtherGREAT LAKES HEALTH PLAN
I15240Medicare UPIN
381908328OtherPPOM