Provider Demographics
NPI:1982646949
Name:KREMER, MICHAEL ADAM (MD, PLC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ADAM
Last Name:KREMER
Suffix:
Gender:M
Credentials:MD, PLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3299 N WELLNESS DR
Mailing Address - Street 2:BLDG 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:BLDG 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
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004034547207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMK091606OtherSTATE LICENSE NUMBER
MI1307011752OtherBCBSM/BCN
MIST003962OtherSTATE LICENSE #
MIST003962OtherSTATE LICENSE #
MI0P17930Medicare PIN
H98565Medicare UPIN