Provider Demographics
NPI:1093705550
Name:KRAMER, DAVID G (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:KRAMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2102 E INWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-2443
Mailing Address - Country:US
Mailing Address - Phone:574-299-2400
Mailing Address - Fax:574-299-2410
Practice Address - Street 1:2102 E INWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46614-2443
Practice Address - Country:US
Practice Address - Phone:574-299-2400
Practice Address - Fax:574-299-2410
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01049672A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200191750Medicaid
INF33218Medicare UPIN
IN200191750Medicaid