Provider Demographics
NPI:1720188204
Name:KRAMER, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:KRAMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 MAXINE DR
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2498
Mailing Address - Country:US
Mailing Address - Phone:309-263-2424
Mailing Address - Fax:309-284-2255
Practice Address - Street 1:435 MAXINE DR
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2498
Practice Address - Country:US
Practice Address - Phone:309-263-2424
Practice Address - Fax:309-284-2255
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H46121Medicare UPIN
ILK23159Medicare ID - Type UnspecifiedINDIVIDUAL #
IL809840Medicare ID - Type UnspecifiedGROUP #