MEDICARE: IAN KRAMER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1386289700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN KRAMER

Provider Business Mailing Address
First Line	:	4013 NW 72ND AVE
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-2132
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4013 NW 72ND AVE
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-2132
Country	:	US
Telephone Number	:	954-415-9978
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2019
Last Update Date	:	11/08/2019

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Directions to “ IAN KRAMER ” Practice Location

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