Healthcare Provider Details

I. General information

NPI: 1467685370
Provider Name (Legal Business Name): JON MICHAEL KRAMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3895 FAIRLINGTON DR
COLUMBUS OH
43220-4530
US

IV. Provider business mailing address

3895 FAIRLINGTON DR
COLUMBUS OH
43220-4530
US

V. Phone/Fax

Practice location:
  • Phone: 734-353-0449
  • Fax:
Mailing address:
  • Phone: 734-353-0449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301065727
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301065727
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: