Basic Information
| Provider Information | |||||||||
| NPI: | 1366769713 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRAMER | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BYE | ||||||||
| OtherFirstName: | CHRISTINA | ||||||||
| OtherMiddleName: | R | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3409 LUDINGTON STREET | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | ESCANABA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9067861356 | ||||||||
| FaxNumber: | 9067894503 | ||||||||
| Practice Location | |||||||||
| Address1: | 3409 LUDINGTON STREET | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | ESCANABA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 49829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9067861356 | ||||||||
| FaxNumber: | 9067894503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2010 | ||||||||
| LastUpdateDate: | 03/07/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 57802 | MN | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 4301502177 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1366769713 | 05 | MI | MEDICAID |