Provider Demographics
NPI:1033172770
Name:KRAMPAT, PHILIP JOHN (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:JOHN
Last Name:KRAMPAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 480240
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33348
Mailing Address - Country:US
Mailing Address - Phone:954-524-2336
Mailing Address - Fax:954-524-2219
Practice Address - Street 1:420 NE 3RD ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301
Practice Address - Country:US
Practice Address - Phone:954-524-2336
Practice Address - Fax:954-524-2219
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00490612084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
08608Medicare ID - Type Unspecified
E22890Medicare UPIN