Healthcare Provider Details

I. General information

NPI: 1962403436
Provider Name (Legal Business Name): CLARK KRAMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 80TH PL
MERRILLVILLE IN
46410-5456
US

IV. Provider business mailing address

PO BOX 781076 STE 400
DETROIT MI
48278-0001
US

V. Phone/Fax

Practice location:
  • Phone: 219-736-1400
  • Fax:
Mailing address:
  • Phone: 317-528-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01028393A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: