Provider Demographics
NPI:1104009125
Name:SOONOK K. CRAMER DPM
Entity Type:Organization
Organization Name:SOONOK K. CRAMER DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOONOK
Authorized Official - Middle Name:K
Authorized Official - Last Name:CRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:217-367-4960
Mailing Address - Street 1:PO BOX 17255
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61803
Mailing Address - Country:US
Mailing Address - Phone:217-367-4960
Mailing Address - Fax:217-383-1083
Practice Address - Street 1:1210 E MAIN ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802
Practice Address - Country:US
Practice Address - Phone:217-367-4960
Practice Address - Fax:217-383-1083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-003898213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4474380001Medicare NSC