Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 211-000270 | IL |
NPI | 1124366265 |
---|---|
Provider Name | Charles E Kramarczyk |
First Address | Beloit, WI 53511-1844 |
Second Address | Beloit, WI 53511-1844 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2013 |
Last Update Date | 24/01/2013 |