Provider Demographics
NPI:1295846699
Name:KRAMER, GREGORY
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:KRAMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34441 8 MILE RD
Mailing Address - Street 2:STE 116
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4013
Mailing Address - Country:US
Mailing Address - Phone:248-615-1533
Mailing Address - Fax:248-615-9068
Practice Address - Street 1:34441 8 MILE RD
Practice Address - Street 2:STE 116
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-4013
Practice Address - Country:US
Practice Address - Phone:248-615-1533
Practice Address - Fax:248-615-9068
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301005503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI950Q25255OtherBCBS
MI0Q25255Medicare ID - Type Unspecified
MI950Q25255OtherBCBS