Provider Demographics
NPI:1124056486
Name:KRAMER, JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:KRAMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5184
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-5184
Mailing Address - Country:US
Mailing Address - Phone:773-691-4267
Mailing Address - Fax:847-745-0321
Practice Address - Street 1:2525 S MICHIGAN AVE
Practice Address - Street 2:SUITE 817
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2333
Practice Address - Country:US
Practice Address - Phone:312-567-2479
Practice Address - Fax:312-328-7970
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360529172084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621816OtherBLUE CROSS BLUE SHIELD ID
ILP00173714OtherRAILROAD MEDICARE ID
IL036052917OtherLICENSE #
IL036052917Medicaid
IL214234OtherMEDICARE GROUP #
IL036052917Medicaid
ILK31398Medicare PIN