Provider Demographics
NPI:1477710952
Name:M. ADAM KREMER, M.D., PLC
Entity Type:Organization
Organization Name:M. ADAM KREMER, M.D., PLC
Other - Org Name:M. ADAM KREMER, M.D., PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:KREMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-738-4420
Mailing Address - Street 1:3299 N WELLNESS DR
Mailing Address - Street 2:BUILDING C, SUITE 240
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-7269
Mailing Address - Country:US
Mailing Address - Phone:616-738-4420
Mailing Address - Fax:616-738-4432
Practice Address - Street 1:3299 N WELLNESS DR
Practice Address - Street 2:BUILDING C, SUITE 240
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-7269
Practice Address - Country:US
Practice Address - Phone:616-738-4420
Practice Address - Fax:616-738-4432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091606207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1307011752OtherBSBM
MIST003962OtherSTATE LICENSE #
MIMK091606OtherSTATE LICENSE#
MI0P59360Medicare PIN
MIST003962OtherSTATE LICENSE #
MIH98565Medicare UPIN