Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 2901017657 | MI |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 2901016237 | MI |
NPI | 1366480238 |
---|---|
Provider Name | Dr. Michael Bartholomew Kraemer |
First Address | Warren, MI 48092-2203 |
Second Address | Warren, MI 48092-2203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 10/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0205016472 | BC MED/SURG PIN (01) | MI |
970E07680 | BLUE CROSS PIN (01) | MI |
I37915 | (02) | MI |