Provider Demographics
NPI:1629092234
Name:DAVID KRAMER MD
Entity Type:Organization
Organization Name:DAVID KRAMER MD
Other - Org Name:OPA-LOCKA MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-688-2519
Mailing Address - Street 1:870 FISHERMAN STREET
Mailing Address - Street 2:
Mailing Address - City:OPA-LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054
Mailing Address - Country:US
Mailing Address - Phone:305-688-2519
Mailing Address - Fax:305-688-2785
Practice Address - Street 1:870 FISHERMAN ST
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-3509
Practice Address - Country:US
Practice Address - Phone:305-688-2519
Practice Address - Fax:305-688-2785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0007088302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110222OtherHUMANA CTR NUMBER