=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235208703
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEFFREY KRAMER, M.D.S.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2006
-----------------------------------------------------
Last Update Date | 03/19/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2525 S MICHIGAN AVE SUITE 817
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60616-2315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-567-2479
-----------------------------------------------------
Fax | 312-328-7970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5184
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60076-5184
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-679-0629
-----------------------------------------------------
Fax | 847-679-0630
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JEFFREY KRAMER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 312-567-2479
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 036052917
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------