Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301110165 | MI |
N | 208600000X | Surgeon | 4301110165 | MI |
Y | 208800000X | Urologist | 4301110165 | MI |
NPI | 1013366491 |
---|---|
Provider Name | Dr. Samantha Denae Kraemer |
First Address | Madison, WI 53716-2257 |
Second Address | Royal Oak, MI 48073-6712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2016 |
Last Update Date | 15/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013366491 | (05) | WI |