Provider Demographics
NPI:1710953757
Name:KRAEMER, PATRICIA S (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:KRAEMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 TRIVERTON PIKE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711
Mailing Address - Country:US
Mailing Address - Phone:608-227-7007
Mailing Address - Fax:608-227-7027
Practice Address - Street 1:2955 TRIVERTON PIKE DRIVE
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711
Practice Address - Country:US
Practice Address - Phone:608-227-7007
Practice Address - Fax:208-227-7027
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27862207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31429200Medicaid
B54306Medicare UPIN
WI010A15875Medicare ID - Type Unspecified