Provider Demographics
NPI:1356402523
Name:KRAMER, THERESA RETUE (MD, MBA)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:RETUE
Last Name:KRAMER
Suffix:
Gender:F
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1563 RESERVE CIR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1538
Mailing Address - Country:US
Mailing Address - Phone:404-320-1933
Mailing Address - Fax:404-929-6763
Practice Address - Street 1:3601 S 6TH AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85723-0001
Practice Address - Country:US
Practice Address - Phone:520-792-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31274207W00000X
SC28210207W00000X
VA0101235997207W00000X
MDD60860207W00000X
AZ20166207W00000X
CAG083620207W00000X
IN01046385A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00426764CMedicaid
GA18BDFLXMedicare ID - Type Unspecified
GA00426764CMedicaid