Provider Demographics
NPI:1528082070
Name:ANDREW S RIEMER DO PC
Entity type:Organization
Organization Name:ANDREW S RIEMER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:RIEMER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-845-6261
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:231-843-9171
Practice Address - Street 1:1352 E PARKDALE AVE
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660
Practice Address - Country:US
Practice Address - Phone:231-723-8363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4921652Medicaid
MI180E300150OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI900E300160OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI820000297OtherRAILROAD MEDICARE
MI180E310290OtherBCBS OF MICHIGAN
MI900F410030OtherBCBS OF MICHIGAN
MI1199540003Medicare NSC
MI900F410030OtherBCBS OF MICHIGAN