Healthcare Provider Details

I. General information

NPI: 1801052105
Provider Name (Legal Business Name): KEVIN LEE RIEMER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DEACONESS RD
BOSTON MA
02215-5321
US

IV. Provider business mailing address

185 PILGRIM RD SPAN 3
BOSTON MA
02215-5324
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-8428
  • Fax:
Mailing address:
  • Phone: 617-632-8428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2344
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: