Provider Demographics
NPI:1366429706
Name:RIEMER, ANDREW S (DO)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:S
Last Name:RIEMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 LAWNDALE ST
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-2921
Mailing Address - Country:US
Mailing Address - Phone:231-845-6261
Mailing Address - Fax:
Practice Address - Street 1:5959 LAWNDALE ST
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431
Practice Address - Country:US
Practice Address - Phone:231-845-6261
Practice Address - Fax:231-843-9171
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101011043207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3046433Medicaid
MI4921661Medicaid
MI820000297OtherRAILROAD MEDICARE
MI180E310290OtherBCBS OF MICHIGAN
MI180E300140OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI4172685Medicaid
MI180E300150OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI4921661Medicaid
MI0M92930006Medicare PIN