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General NPI Number Information
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NPI Number | 1801955331
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Entity Type | Organization
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Legal Business Name | HKB CORPORATION
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 4190 24TH AVE SUITE 104
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3882
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Country | US
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Telephone | 810-989-7711
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Fax | 810-987-7111
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Provider Business Mailing Address
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Address Line | 4190 24TH AVE SUITE 104
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City | FORT GRATIOT
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State | MI
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Zip | 48059-3882
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Country | US
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Telephone | 810-989-7711
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Fax | 810-987-7111
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN BREMER
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Credential | D.P.M.
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Telephone | 810-989-7711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 5901000901
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License Number State | MI
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