Provider Demographics
NPI:1578630968
Name:BREMER, STEVEN W (DPM)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:W
Last Name:BREMER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4190 24TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FORT GRATIOT
Mailing Address - State:MI
Mailing Address - Zip Code:48059-3882
Mailing Address - Country:US
Mailing Address - Phone:810-989-7711
Mailing Address - Fax:810-987-7111
Practice Address - Street 1:4190 24TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FORT GRATIOT
Practice Address - State:MI
Practice Address - Zip Code:48059-3882
Practice Address - Country:US
Practice Address - Phone:810-989-7711
Practice Address - Fax:810-987-7111
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000901213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5745003OtherBCBS
MI8745000Medicare PIN
MIU21054Medicare UPIN
MI0P44230001Medicare PIN