Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 35279 | MN |
NPI | 1023050036 |
---|---|
Provider Name | Dr. Mark Kraemer |
First Address | Minneapolis, MN 55407-1321 |
Second Address | Minneapolis, MN 55433-2522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 22/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
089860100 | (05) | MN |
F44359 | (02) | MN |