Provider Demographics
NPI:1659396158
Name:KRAMER, MICHAEL JOHN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
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 1:4535 DRESSLER RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2545
Mailing Address - Country:US
Mailing Address - Phone:330-493-4443
Mailing Address - Fax:330-493-8677
Practice Address - Street 1:102 E LAKE MEAD PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5575
Practice Address - Country:US
Practice Address - Phone:702-616-4600
Practice Address - Fax:702-616-4604
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2455A207P00000X
IL036070496207P00000X
CO27024207P00000X
NV5226207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY605960009OtherUSDLAB
WY314437OtherBSWY
NV2002032Medicaid
WY1659396158Medicaid
NVCC3519OtherBCBS NV
NVD44132Medicare UPIN
WY314437OtherBSWY
WY605960009OtherUSDLAB