Provider Demographics
NPI:1427271097
Name:TREMP, STACEY S (DO)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:S
Last Name:TREMP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1650 HASLETT RD
Mailing Address - Street 2:
Mailing Address - City:HASLETT
Mailing Address - State:MI
Mailing Address - Zip Code:48840-7615
Mailing Address - Country:US
Mailing Address - Phone:517-853-5588
Mailing Address - Fax:517-853-5577
Practice Address - Street 1:1650 HASLETT RD
Practice Address - Street 2:
Practice Address - City:HASLETT
Practice Address - State:MI
Practice Address - Zip Code:48840-7615
Practice Address - Country:US
Practice Address - Phone:517-853-5588
Practice Address - Fax:517-853-5577
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101015755207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1653305474OtherBCBS PIN
MI1427271097Medicaid
MI0C36084058Medicare PIN