Provider Demographics
NPI:1932692688
Name:KRAMER, BRETT TYLER (CPO)
Entity Type:Individual
Prefix:MR
First Name:BRETT
Middle Name:TYLER
Last Name:KRAMER
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 EXECUTIVE CT STE 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9543
Mailing Address - Country:US
Mailing Address - Phone:847-382-3222
Mailing Address - Fax:
Practice Address - Street 1:20 EXECUTIVE CT STE 2
Practice Address - Street 2:
Practice Address - City:SOUTH BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9543
Practice Address - Country:US
Practice Address - Phone:184-738-2322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213.000121222Z00000X
IL211.000166224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist