Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 5986 | WI |
NPI | 1144259581 |
---|---|
Provider Name | Andrew J Kramer |
First Address | Madison, WI 53715 |
Second Address | Madison, WI 53715-1348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 08/07/2007 |