Healthcare Provider Details

I. General information

NPI: 1720210982
Provider Name (Legal Business Name): DIANA KRAEMER MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 TALBOT RD S SUITE 315
RENTON WA
98055-6238
US

IV. Provider business mailing address

PO BOX 13684
SEATTLE WA
98198-1010
US

V. Phone/Fax

Practice location:
  • Phone: 425-572-5447
  • Fax: 425-572-5449
Mailing address:
  • Phone: 206-592-5000
  • Fax: 206-824-9510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00029598
License Number StateWA

VIII. Authorized Official

Name: DIANA KRAEMER
Title or Position: OWNER
Credential: MD
Phone: 425-572-5447