Healthcare Provider Details

I. General information

NPI: 1760477749
Provider Name (Legal Business Name): EDWIN T KRAEMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 LEES SUMMIT RD
KANSAS CITY MO
64139-1236
US

IV. Provider business mailing address

7900 LEES SUMMIT RD
KANSAS CITY MO
64139-1236
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-7100
  • Fax: 816-404-7612
Mailing address:
  • Phone: 816-404-7100
  • Fax: 816-404-7612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD R5J63
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: