MEDICARE: LISA B KREMER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	G076815	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1841494275	OTHER		GROUP NPI
3	943412643	OTHER	CA	BLUE CROSS

General Provider Information

NPI Number	:	1144262213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA B KREMER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 254947
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95865-4947
Country	:	US
Telephone Number	:	916-854-6975
Fax Number	:	916-854-6844

Provider Business Practice Location Address
First Line	:	4725 HOEN AVE STE A
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-9405
Country	:	US
Telephone Number	:	707-576-3322
Fax Number	:	707-576-3323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	01/06/2012

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