Healthcare Provider Details

I. General information

NPI: 1912450818
Provider Name (Legal Business Name): BRAD E KREMER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 SPRING ARBOR RD
JACKSON MI
49203-2797
US

IV. Provider business mailing address

2195 SPRING ARBOR RD
JACKSON MI
49203-2797
US

V. Phone/Fax

Practice location:
  • Phone: 517-539-6111
  • Fax: 517-539-6110
Mailing address:
  • Phone: 517-539-6111
  • Fax: 517-539-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301091114
License Number StateMI

VIII. Authorized Official

Name: DONNA STETLER
Title or Position: OFFICE MANAGER
Credential: R.T.
Phone: 517-539-6111