Healthcare Provider Details

I. General information

NPI: 1477086874
Provider Name (Legal Business Name): OWEN NEALE KRAMER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N HAVEN RD STE 7
ELMHURST IL
60126-2973
US

IV. Provider business mailing address

PO BOX 734240
CHICAGO IL
60673-5147
US

V. Phone/Fax

Practice location:
  • Phone: 630-832-2111
  • Fax: 630-832-5199
Mailing address:
  • Phone: 615-277-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number036.152879
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: