Provider Demographics
NPI:1003893975
Name:KRAMER, HOLLY (MD)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:KRAMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:101-1740 LOYOLA UNIVERSITY MEDICAL CENTER
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-327-9039
Mailing Address - Fax:708-327-9009
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:101-1740 LOYOLA UNIVERSITY MEDICAL CENTER
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-9000
Practice Address - Fax:708-216-9033
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36106749207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36106749Medicaid
IL36106749Medicaid
H76409Medicare UPIN