Provider Demographics
NPI:1083685952
Name:KAMMER, GARY M (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:M
Last Name:KAMMER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7590 AUBURN RD STE 14
Mailing Address - Street 2:
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9176
Mailing Address - Country:US
Mailing Address - Phone:409-541-8994
Mailing Address - Fax:409-541-1845
Practice Address - Street 1:5105 SOM CENTER RD # 105
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4203
Practice Address - Country:US
Practice Address - Phone:440-953-8700
Practice Address - Fax:440-953-8796
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2021-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35 . 032567207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0399251Medicaid
OHH480820OtherMEDICARE
OHKA4128961Medicare ID - Type Unspecified
OHA79029Medicare UPIN