Provider Demographics
NPI:1548493240
Name:REMMLER, MARK JOSEPH (PA-C)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:REMMLER
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:BOX 67
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-6022
Mailing Address - Fax:269-341-8244
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:BRONSON TRAUMA DEPARTMENT, BOX 67
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-6022
Practice Address - Fax:269-341-8244
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2023-11-27
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Provider Licenses
StateLicense IDTaxonomies
MI5601005591363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1548493240Medicaid
MI2053900680OtherBCBS
MI1548493240Medicaid
MIC97618189Medicare PIN