Healthcare Provider Details

I. General information

NPI: 1043661002
Provider Name (Legal Business Name): KYRIE CRAMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date: 06/03/2021
Reactivation Date: 06/25/2021

III. Provider practice location address

142 HELLE BLVD APT 212
DUNDEE MI
48131-9408
US

IV. Provider business mailing address

142 HELLE BLVD APT 212
DUNDEE MI
48131-9408
US

V. Phone/Fax

Practice location:
  • Phone: 734-693-9973
  • Fax:
Mailing address:
  • Phone: 734-693-9973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: