Provider Demographics
NPI:1760493555
Name:KRAM, MARTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:KRAM
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 1:530 S CARRIER PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-1502
Mailing Address - Country:US
Mailing Address - Phone:972-264-9111
Mailing Address - Fax:972-264-9120
Practice Address - Street 1:530 S CARRIER PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1502
Practice Address - Country:US
Practice Address - Phone:972-264-9111
Practice Address - Fax:972-264-9120
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK55932084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0001HKOtherBCBS
TX10011658OtherAMERIGROUP
455535OtherVALUE OPTIONS
TX0001HKOtherBCBS
TX00319QMedicare ID - Type Unspecified