Healthcare Provider Details

I. General information

NPI: 1578552790
Provider Name (Legal Business Name): MICHAEL J KRAEMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 W 6TH AVE SUITE 700
SPOKANE WA
99204-2730
US

IV. Provider business mailing address

508 W 6TH AVE SUITE 700
SPOKANE WA
99204-2730
US

V. Phone/Fax

Practice location:
  • Phone: 509-747-1624
  • Fax: 509-747-6774
Mailing address:
  • Phone: 509-747-1624
  • Fax: 509-747-6774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD00016924
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: