Provider Demographics
NPI:1093971574
Name:KRAMER, ADAM TODD (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:TODD
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 1:13090 N 94TH DR STE 212
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4258
Mailing Address - Country:US
Mailing Address - Phone:833-578-7246
Mailing Address - Fax:602-714-7176
Practice Address - Street 1:13090 N 94TH DR STE 212
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4258
Practice Address - Country:US
Practice Address - Phone:855-766-6726
Practice Address - Fax:602-714-7176
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48740208VP0014X, 207LP2900X
IL125055091207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ894562Medicaid