Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 5101015755 | MI |
NPI | 1427271097 |
---|---|
Provider Name | Dr. Stacey S Tremp |
First Address | Haslett, MI 48840-7615 |
Second Address | Haslett, MI 48840-7615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 05/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1427271097 | (05) | MI |
1653305474 | BCBS PIN (01) | MI |