Basic Information
| Provider Information | |||||||||
| NPI: | 1093705550 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRAMER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2102 E INWOOD RD | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466142443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742992400 | ||||||||
| FaxNumber: | 5742992410 | ||||||||
| Practice Location | |||||||||
| Address1: | 2102 E INWOOD RD | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466142443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5742992400 | ||||||||
| FaxNumber: | 5742992410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 08/02/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01049672A | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200191750 | 05 | IN | MEDICAID |