Provider Demographics
NPI:1720210982
Name:DIANA KRAEMER MD PLLC
Entity Type:Organization
Organization Name:DIANA KRAEMER MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAEMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-572-5447
Mailing Address - Street 1:PO BOX 13684
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98198-1010
Mailing Address - Country:US
Mailing Address - Phone:206-592-5000
Mailing Address - Fax:206-824-9510
Practice Address - Street 1:4300 TALBOT RD S
Practice Address - Street 2:SUITE 315
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6238
Practice Address - Country:US
Practice Address - Phone:425-572-5447
Practice Address - Fax:425-572-5449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029598174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty