Basic Information
| Provider Information | |||||||||
| NPI: | 1265419006 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRAMBECK | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 675 N SAINT CLAIR ST STE 20-150 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606115979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126958146 | ||||||||
| FaxNumber: | 3126957030 | ||||||||
| Practice Location | |||||||||
| Address1: | 675 N SAINT CLAIR ST STE 20-150 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606115979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126958146 | ||||||||
| FaxNumber: | 3126957030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2005 | ||||||||
| LastUpdateDate: | 01/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 45767 | MN | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 036154616 | IL | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 35237400 | 05 | WI | MEDICAID | P00042729 | 01 | MN | RAILROAD MEDICARE | OTHER | 068449000 | 05 | MN | MEDICAID | ENROLLED | 05 | IA | MEDICAID |