Healthcare Provider Details

I. General information

NPI: 1710001649
Provider Name (Legal Business Name): MARTIN CONRAD KRAMER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 CASTRO ST
SAN FRANCISCO CA
94114-2511
US

IV. Provider business mailing address

220 LOMBARD ST APT 118
SAN FRANCISCO CA
94111-1157
US

V. Phone/Fax

Practice location:
  • Phone: 415-529-4099
  • Fax: 415-291-0489
Mailing address:
  • Phone: 415-433-5359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12310
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: