Provider Demographics
NPI:1437113032
Name:KAZMERS, IRENE S (MD)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:S
Last Name:KAZMERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IRENE
Other - Middle Name:S
Other - Last Name:UEYAMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3280 WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-8105
Mailing Address - Country:US
Mailing Address - Phone:231-348-3800
Mailing Address - Fax:877-529-6854
Practice Address - Street 1:3280 WOODS WAY
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8105
Practice Address - Country:US
Practice Address - Phone:231-348-3800
Practice Address - Fax:877-529-6854
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301041105207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104627337Medicaid
MIA14964Medicare UPIN
MI104627337Medicaid