Provider Demographics
NPI:1093746927
Name:KRAMER, JASON SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:SCOTT
Last Name:KRAMER
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 1:225 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-4304
Mailing Address - Country:US
Mailing Address - Phone:847-941-7600
Mailing Address - Fax:
Practice Address - Street 1:36100 N BROOKSIDE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-4571
Practice Address - Country:US
Practice Address - Phone:847-856-2090
Practice Address - Fax:847-856-2093
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036101800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL364456682OtherTAX IDENTIFICATION #
10593795OtherCAQH PROVIDER #
IL036101800OtherSTATE LICENSE #
IL04930316OtherBCBS PROVIDER #
IL336062496OtherCONTROLLED SUBSTANCE #
IL336062496OtherCONTROLLED SUBSTANCE #
IL364456682OtherTAX IDENTIFICATION #
10593795OtherCAQH PROVIDER #
BK6716407OtherDEA #