Basic Information
Provider Information
NPI: 1447268610
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CREMER
FirstName: MICHAEL
MiddleName: ALAN
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1482 HOLLOW FORK CV
Address2:  
City: GERMANTOWN
State: TN
PostalCode: 381381719
CountryCode: US
TelephoneNumber: 9017517176
FaxNumber:  
Practice Location
Address1: 1030 JEFFERSON AVE
Address2:  
City: MEMPHIS
State: TN
PostalCode: 381042127
CountryCode: US
TelephoneNumber: 9015238990
FaxNumber: 9015777286
Other Information
ProviderEnumerationDate: 08/04/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RR0500XMD8152TNY Allopathic & Osteopathic PhysiciansInternal MedicineRheumatology

No ID Information.


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