Basic Information
Provider Information
NPI: 1548226624
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REMMLER
FirstName: DAVID
MiddleName: ERIK
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: DEPARTMENT 272801
Address2: PO BOX 67000
City: DETROIT
State: MI
PostalCode: 48267
CountryCode: US
TelephoneNumber: 5178416913
FaxNumber: 5178416917
Practice Location
Address1: 205 N EAST AVE
Address2:  
City: JACKSON
State: MI
PostalCode: 492011753
CountryCode: US
TelephoneNumber: 5177884996
FaxNumber: 5177966410
Other Information
ProviderEnumerationDate: 04/26/2006
LastUpdateDate: 11/23/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X4301061892MIY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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