Provider Demographics
NPI:1649219346
Name:KRAMER, LESLIE (DO)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:KRAMER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2449
Mailing Address - Country:US
Mailing Address - Phone:319-362-3434
Mailing Address - Fax:319-362-9568
Practice Address - Street 1:411 10TH ST SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-2442
Practice Address - Country:US
Practice Address - Phone:319-362-3434
Practice Address - Fax:319-362-9568
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02692174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1076604Medicaid
IA1076604Medicaid
IA50185Medicare ID - Type UnspecifiedMEDICARE