MEDICARE: ANGELA PETERSON KRAMER PA-C

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	363A00000X	Physician Assistant	10048	MN

General Provider Information

NPI Number	:	1255310918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA PETERSON KRAMER PA-C

Provider Business Mailing Address
First Line	:	6495 CRAIG DR
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55346-1328
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	516 DELAWARE ST SE
Second Line	:	14-148 PWB
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55455-0356
Country	:	US
Telephone Number	:	612-625-2654
Fax Number	:

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	06/06/2012

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