MEDICARE: MICHELLE ANN CRAMP

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	2085R0204X	Vascular & Interventional Radiology Physician	960559	DC
2	363LA2200X	Adult Health Nurse Practitioner	10686-NP	OH
3	363LF0000X	Family Nurse Practitioner	COA10686-NP	OH
4	363L00000X	Nurse Practitioner	10686-NP	OH
5	2086S0129X	Vascular Surgery Physician	COA10686-NP	OH

General Provider Information

NPI Number	:	1932107091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ANN CRAMP

Provider Business Mailing Address
First Line	:	36060 EUCLID AVE STE 107
Second Line	:
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-4661
Country	:	US
Telephone Number	:	440-269-8346
Fax Number	:

Provider Business Practice Location Address
First Line	:	36060 EUCLID AVE STE 107
Second Line	:
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-4661
Country	:	US
Telephone Number	:	440-269-8346
Fax Number	:

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

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	07/18/2019

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